Basic Information
Provider Information
NPI: 1003806621
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DESANTOLA
FirstName: JOSEPH
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1869
Address2:  
City: FLETCHER
State: NC
PostalCode: 287321869
CountryCode: US
TelephoneNumber: 8286875616
FaxNumber: 8286508076
Practice Location
Address1: 50 HOSPITAL DR
Address2: SUITE 3B2
City: HENDERSONVILLE
State: NC
PostalCode: 287925248
CountryCode: US
TelephoneNumber: 8286870088
FaxNumber: 8286846693
Other Information
ProviderEnumerationDate: 10/25/2005
LastUpdateDate: 12/06/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X201201997NCY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0000XMD032977EPAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

ID Information
IDTypeStateIssuerDescription
P0124813001NCMEDICARE RROTHER
176U701NCBCBS NCOTHER


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