Provider Demographics
NPI:1194081463
Name:DAVID J. DISANTO, M.D. INC
Entity type:Organization
Organization Name:DAVID J. DISANTO, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DISANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-431-0226
Mailing Address - Street 1:2464 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3218
Mailing Address - Country:US
Mailing Address - Phone:401-431-0226
Mailing Address - Fax:401-434-3166
Practice Address - Street 1:2464 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3218
Practice Address - Country:US
Practice Address - Phone:401-431-0226
Practice Address - Fax:401-434-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05417207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty