Healthcare Provider Details

I. General information

NPI: 1235139866
Provider Name (Legal Business Name): SANTO M BORGANELLI MD FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SOUTH 28TH AVENUE
HATTIESBURG MS
39401
US

IV. Provider business mailing address

415 SOUTH 28TH AVENUE
HATTIESBURG MS
39401
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-5800
  • Fax: 601-261-3530
Mailing address:
  • Phone: 601-268-5800
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number20405
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: