Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 201201997 | NC |
N | 207RC0000X | Internist - Cardiovascular Disease | MD032977E | PA |
NPI | 1003806621 |
---|---|
Provider Name | Joseph R Desantola |
First Address | Fletcher, NC 28732-1869 |
Second Address | Hendersonville, NC 28792-5248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176U7 | BCBS NC (01) | NC |
B42221 | (02) | |
P01248130 | MEDICARE RR (01) | NC |