Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 83046 | SC |
Y | 208600000X | Surgeon | 83046 | SC |
N | 2086S0102X | Surgical Critical Care | 83046 | SC |
NPI | 1255777603 |
---|---|
Provider Name | Tara-Marie Dinitto |
First Address | Myrtle Beach, SC 29572-4614 |
Second Address | Myrtle Beach, SC 29572-4614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 05/11/2019 |