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General NPI Number Information
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NPI Number | 1700141413
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Entity Type | Organization
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Legal Business Name | SANTE INTEGRATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 49 PRINCE ST
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City | HARRISBURG
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State | PA
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Zip | 17109-3113
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Country | US
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Telephone | 717-545-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 304 BLACKLATCH LN
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City | CAMP HILL
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State | PA
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Zip | 17011-8412
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Country | US
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Telephone | 717-737-9646
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CONSTANCE DELINE
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Credential | MD
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Telephone | 717-737-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD065431L
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License Number State | PA
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