Provider Demographics
NPI:1275591919
Name:DALESSIO, SANTA (MD)
Entity Type:Individual
Prefix:
First Name:SANTA
Middle Name:
Last Name:DALESSIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2751
Mailing Address - Country:US
Mailing Address - Phone:540-771-3032
Mailing Address - Fax:540-713-0427
Practice Address - Street 1:2055 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2751
Practice Address - Country:US
Practice Address - Phone:540-771-3032
Practice Address - Fax:540-713-0427
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231825207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
110235048OtherRAILROAD MEDICARE
WV1808081000Medicaid
VA005869625Medicaid
110235048Medicare PIN
WV1808081000Medicaid
VA110008353Medicare PIN