Healthcare Provider Details

I. General information

NPI: 1629064423
Provider Name (Legal Business Name): JOSEPH VINCENT DE SANTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 BOILER HOUSE RD BLDG 361
PERRY POINT MD
21902-1103
US

IV. Provider business mailing address

2718 WOODSPRING DR
YORK PA
17402-8521
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 717-718-5465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD423667
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD423667
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: