Healthcare Provider Details

I. General information

NPI: 1487668984
Provider Name (Legal Business Name): CATHERINE A DISANTI AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8818 CENTRE PARK DRIVE SUITE 107
COLUMBIA MD
21045
US

IV. Provider business mailing address

8818 CENTRE PARK DRIVE SUITE 107
COLUMBIA MD
21045
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-4885
  • Fax: 410-740-4677
Mailing address:
  • Phone: 410-740-4885
  • Fax: 410-740-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00490
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: