Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9401171 | NC |
NPI | 1003809542 |
---|---|
Provider Name | Mr. Thomas Calvin Dimartino |
First Address | Edenton, NC 27932-9668 |
Second Address | Edenton, NC 27932-9668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 03/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8928501 | (05) | NC |
E94162 | (02) |