1629042858 NPI number — MEGAN G DESANTIS PA

Table of content: MEGAN G DESANTIS PA (NPI 1629042858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629042858 NPI number — MEGAN G DESANTIS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESANTIS
Provider First Name:
MEGAN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629042858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 QUAIL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03109-5930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-232-1976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 ELLIOT WAY
Provider Second Line Business Practice Location Address:
SUITE302
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03103-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-627-1887
Provider Business Practice Location Address Fax Number:
603-627-1890
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  0462 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30332481 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com