Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | OS-004-046-L | PA |
Y | 208600000X | Surgeon | OS-004-046-L | PA |
N | 208D00000X | General Practice Physician | OS-004-046-L | PA |
NPI | 1023348158 |
---|---|
Provider Name | Carmen N Dimario |
First Address | West Chester, PA 19382-6962 |
Second Address | Bala Cynwyd, PA 19004-1021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 23/03/2018 |