Provider Demographics
NPI:1457881849
Name:DESANTO, CORINNE (PA-C)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:DESANTO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:
Other - Last Name:FANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3803 W CHESTER PIKE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVENUE
Practice Address - Street 2:SUITE 275 MED SCI BLDG
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:484-476-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059019363A00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant