Provider Demographics
NPI:1629064423
Name:DE SANTI, JOSEPH VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
Last Name:DE SANTI
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 1:61 N. WALNUT STREET
Mailing Address - Street 2:#361
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-0361
Mailing Address - Country:US
Mailing Address - Phone:717-718-5465
Mailing Address - Fax:
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-718-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423667207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101108315Medicaid
I16182Medicare UPIN
PA101108315Medicaid