Healthcare Provider Details

I. General information

NPI: 1619538758
Provider Name (Legal Business Name): MORGAN ELISABETH SANTILLI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN ELISABETH LAITER PA

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date: 01/12/2021
Reactivation Date: 05/25/2021

III. Provider practice location address

120 CENTERVILLE RD STE 5
WARWICK RI
02886-4336
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-562-1017
  • Fax:
Mailing address:
  • Phone: 401-788-8757
  • Fax: 401-782-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01448
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: