Provider Demographics
NPI:1003271644
Name:DIMARTINO, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 LEE-ANN DRIVE, NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1028 LEE-ANN DRIVE, NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2915
Practice Address - Country:US
Practice Address - Phone:704-782-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant