Basic Information
| Provider Information | |||||||||
| NPI: | 1235139866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORGANELLI | ||||||||
| FirstName: | SANTO | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD FACC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 SOUTH 28TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012685800 | ||||||||
| FaxNumber: | 6015795240 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 SOUTH 28TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012685800 | ||||||||
| FaxNumber: | 6012613530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 20405 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 09933313 | 05 | MS | MEDICAID | 009304150 | 05 | AL | MEDICAID | 3721922 00 | 05 | FL | MEDICAID |