Provider Demographics
NPI:1104978204
Name:DESANTIS, LINDA SUSAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUSAN
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2827
Mailing Address - Country:US
Mailing Address - Phone:724-836-8369
Mailing Address - Fax:724-836-4449
Practice Address - Street 1:325 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2827
Practice Address - Country:US
Practice Address - Phone:724-836-8369
Practice Address - Fax:724-836-4449
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000502L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS06946Medicare UPIN
PA063853Medicare ID - Type Unspecified