Provider Demographics
NPI:1235193178
Name:DESANTIS, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 ROOSEVELT WAY NE
Mailing Address - Street 2:STE 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6099
Mailing Address - Country:US
Mailing Address - Phone:206-598-4882
Mailing Address - Fax:206-598-4976
Practice Address - Street 1:4225 ROOSEVELT WAY NE
Practice Address - Street 2:STE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6099
Practice Address - Country:US
Practice Address - Phone:206-598-4882
Practice Address - Fax:206-598-4976
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-092846207RE0101X
WAMD00046201207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39836Medicare UPIN