Provider Demographics
NPI:1083668537
Name:DIMAGUILA, MARY ANN VT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:VT
Last Name:DIMAGUILA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:628 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7730
Mailing Address - Country:US
Mailing Address - Phone:336-478-1016
Mailing Address - Fax:336-851-1737
Practice Address - Street 1:628 GREEN VALLEY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7730
Practice Address - Country:US
Practice Address - Phone:336-478-1016
Practice Address - Fax:336-851-1737
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9600517208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5821100OtherAETNA
NC1000COtherBCBS NC
NC891000CMedicaid
NC66782OtherMEDCOST
NC66782OtherMEDCOST