Provider Demographics
NPI:1104080977
Name:DE SANTIS, MARCO MAURO (DO)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:MAURO
Last Name:DE SANTIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 WEST MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-1740
Mailing Address - Fax:855-299-8816
Practice Address - Street 1:1272 WEST MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-1740
Practice Address - Fax:220-564-1741
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013718207R00000X, 207RE0101X
MI5101017743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine