1669479531 NPI number — FREDERICK DIMEO P.A.

Table of content: FREDERICK DIMEO P.A. (NPI 1669479531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669479531 NPI number — FREDERICK DIMEO P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMEO
Provider First Name:
FREDERICK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1669479531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
640 S STATE ST
Provider Second Line Business Mailing Address:
POB BLDG--3RD FLOOR
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-480-1688
Provider Business Mailing Address Fax Number:
302-257-5777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 S BAY RD STE 1F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19901-4694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-730-4366
Provider Business Practice Location Address Fax Number:
302-730-0231
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C50000194 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: C50000194 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000015430 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168809ZA5H . This is a "MEDICARE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com