Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 9600517 | NC |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 9600517 | NC |
NPI | 1083668537 |
---|---|
Provider Name | Dr. Mary Ann V.t. Dimaguila |
First Address | Greensboro, NC 27408-7730 |
Second Address | Greensboro, NC 27408-7730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 14/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000C | BCBS NC (01) | NC |
5821100 | AETNA (01) | NC |
66782 | MEDCOST (01) | NC |
891000C | (05) | NC |
G17131 | (02) |