Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS010225 | PA |
NPI | 1003848292 |
---|---|
Provider Name | Nicholas Dimartino |
First Address | Quakertown, PA 18951-3266 |
Second Address | Quakertown, PA 18951-3266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 30/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F90658 | (02) | PA |