Provider Demographics
NPI:1518081520
Name:DISANTO, RACHEL BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:BETH
Last Name:DISANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 896199
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6199
Mailing Address - Country:US
Mailing Address - Phone:833-936-1364
Mailing Address - Fax:605-942-7505
Practice Address - Street 1:310 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5319
Practice Address - Country:US
Practice Address - Phone:704-873-3269
Practice Address - Fax:704-871-8159
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT0420011333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013937Medicaid