Individual
DANIEL G DISANDRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 COOPER PLZ, SUITE 500, CAMDEN, NJ 08103-1438
(856) 342-2627
Mailing address
3 COOPER PLZ, SUITE 500, CAMDEN, NJ 08103-1438
(856) 342-2627
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD056868L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015577760
—
PA
01
—
0015577760007
PROMISE
PA
01
—
0985174000
KEYSTONE
PA
01
—
1037820
KEYSTONE MERCY
—
01
—
869945
BS
PA
Enumeration date
06/30/2006
Last updated
04/22/2016
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