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:
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Other - Credentials:
Mailing Address - Street 1:2718 WOODSPRING DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8521
Mailing Address - Country:US
Mailing Address - Phone:717-718-5465
Mailing Address - Fax:
Practice Address - Street 1:361 BOILER HOUSE RD BLDG 361
Practice Address - Street 2:
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902-1103
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423667207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101108315Medicaid
I16182Medicare UPIN
PA101108315Medicaid