Provider Demographics
NPI:1619973674
Name:DE SANTIS, LUIGI (MD)
Entity Type:Individual
Prefix:
First Name:LUIGI
Middle Name:
Last Name:DE SANTIS
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-946-4410
Mailing Address - Fax:215-946-5846
Practice Address - Street 1:50 SERPENTINE LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-2213
Practice Address - Country:US
Practice Address - Phone:215-946-4410
Practice Address - Fax:215-946-5846
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034446E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA45642MD034446EOtherHEALTH PARTNERS
PAP00851209OtherRAILROAD MEDICARE
PA0016091100003Medicaid
PA30072737OtherKEYSTONE MERCY
PA0022024000OtherKEYSTONE IBC
PA464063OtherAETNA HMO
PA056410OtherHIGHMARK BLUE SHIELD
PA45642MD034446EOtherHEALTH PARTNERS
PA30072737OtherKEYSTONE MERCY