Provider Demographics
NPI:1649201963
Name:DESANTIS, JAMES P (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:DESANTIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1232
Mailing Address - Country:US
Mailing Address - Phone:814-768-2470
Mailing Address - Fax:814-768-2374
Practice Address - Street 1:809 TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1232
Practice Address - Country:US
Practice Address - Phone:814-768-2470
Practice Address - Fax:814-768-2374
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0040A8L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011447500001Medicaid
PA1011447500001Medicaid