Provider Demographics
NPI:1255332243
Name:DILORETO, DAVID DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DANIEL
Last Name:DILORETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:704-855-8338
Mailing Address - Fax:704-855-8339
Practice Address - Street 1:307 E THOM ST
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2363
Practice Address - Country:US
Practice Address - Phone:704-855-8338
Practice Address - Fax:704-855-8339
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28307OtherBLUE CROSS BLUE SHIELD NC
NC8928307Medicaid
NC8928307Medicaid
NC0480730001Medicare NSC
NC2410573DMedicare PIN