Provider Demographics
NPI:1265536353
Name:DESPERITO, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DESPERITO
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 1:2000 FOULK ROAD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810
Mailing Address - Country:US
Mailing Address - Phone:302-652-8990
Mailing Address - Fax:302-652-8646
Practice Address - Street 1:2000 FOULK ROAD
Practice Address - Street 2:SUITE F
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810
Practice Address - Country:US
Practice Address - Phone:302-652-8990
Practice Address - Fax:302-652-8646
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006813208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
61668248OtherBCBS
52148OtherALLIANCE PAYOR ID
2115756OtherOPTIMUM CHOICE
2115756OtherALLIANCE
1000023442OtherDELAWARE PHYSICIANS
1000030166OtherEDS
1000030166OtherDIAMOND STATE PARTNERS
2115756OtherMAMSI
1619558OtherAMERIHEALTH PERS CHOICE H
2297291000OtherAMERIHEALTH HMO
H80122OtherFEDERAL UPN
P00079909OtherRAILROAD MEDICARE
191931OtherCOVENTRY
2297291000OtherKEYSTONE EAST
3075695OtherAETNA
3075695OtherAETNA
G01124Medicare ID - Type UnspecifiedUPN
191931OtherCOVENTRY
DE00B674U24Medicare PIN