Donald Desantis, M.D.
Individual provider Active NPI Surgery Physician · Berwyn, PA
NPI 1528034071 · NPPES record last updated Apr 10, 2017
Key facts
- NPI
- 1528034071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 200200107 (NC)
- Practice address
- 552A Lancaster Ave
Berwyn, PA 19312-1635 - Phone
- (610) 644-7100
- Fax
- (610) 644-7111
- NPI assigned
- Feb 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200200107 | NC | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jersey Shore Hospital Foundation, Inc | Surgery | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 200200107 | NC | Yes |
Addresses
Primary practice location
552A Lancaster Ave
Berwyn, PA 19312-1635
Mailing address
552A Lancaster Ave
Berwyn, PA 19312-1635
Phone (610) 644-7100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700922 | Other | NC | UNITED HEALTHCARE NUMBER |
| 5435826 | Other | NC | CIGNA NUMBER |
| 89137P1 | Medicaid | NC | |
| 4087699 | Other | NC | AETNA NUMBER |
| D5599 | Other | NC | MEDCOST NUMBER |
| 2130600 | Other | NC | MAMSI NUMBER |
| 137P1 | Other | NC | BCBS NUMBER |
| 804764 | Other | NC | PARTNERS MEDICARE CHOICE |
Other providers in Berwyn, PA
- Daemion Counseling Center, Inc.
- Madhura Damle
- David M. Taylor D.M.D and Eileen Leone-Taylor D.M.D Partners
- Nicole M. Davis
- Amy Deahl-Greenlaw
- Louis M Destefano
- Devereux Foundation
- Devereux Foundation
- Devereux Foundation
- Devereux Foundation
All providers in Berwyn, PA · Surgery Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.