Provider Demographics
NPI:1558463299
Name:DESANCTIS, ARMAND NEAL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:NEAL
Last Name:DESANCTIS
Suffix:JR
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 1:2101 FOULK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-475-2535
Mailing Address - Fax:302-475-2720
Practice Address - Street 1:2101 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-475-2535
Practice Address - Fax:302-475-2720
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000610101Medicaid
B66434Medicare UPIN
DE0000610101Medicaid