1760426357 NPI number — DR. DEAN V DIMOTSIS D.P.M.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760426357 NPI number — DR. DEAN V DIMOTSIS D.P.M.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DIMOTSIS

Provider First Name:

DEAN

Provider Middle Name:

V

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D.P.M.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1760426357

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/24/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

15 PRATTS RUN

Provider Second Line Business Mailing Address:

#105

Provider Business Mailing Address City Name:

WAYNESBORO

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22980-6606

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

540-946-9177

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

15 PRATTS RUN

Provider Second Line Business Practice Location Address:

#105

Provider Business Practice Location Address City Name:

WAYNESBORO

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22980-6606

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

540-946-9177

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213E00000X , with the licence number:  0103000371 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1336330620 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1588847982 . This is a "NPI GROUP LEXINGTON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1336330620 . This is a "VIRGINIA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1336330620 . This is a "VIRGINIA HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1336330620 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 283489 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1336330620 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
• Identifier: 1760426357 . This is a "NPI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: C10346 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 035371 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: P00444410 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: DG6187 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".