Provider Demographics
NPI:1194707265
Name:DESANTO, JANICE (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:DESANTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8091 TOWNSHIP LINE RD
Mailing Address - Street 2:ST. VINCENT WOMEN'S HOSPITAL, SUITE 207 MOB
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2494
Mailing Address - Country:US
Mailing Address - Phone:317-415-7921
Mailing Address - Fax:317-415-7922
Practice Address - Street 1:8091 TOWNSHIP LINE RD
Practice Address - Street 2:ST. VINCENT WOMEN'S HOSPITAL, SUITE 207 MOB
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2494
Practice Address - Country:US
Practice Address - Phone:317-415-7921
Practice Address - Fax:317-415-7922
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350654912080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0940521Medicaid