Provider Demographics
NPI:1295222743
Name:DIMAANDAL, IAN LIMUEL ELQUIERO (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN LIMUEL
Middle Name:ELQUIERO
Last Name:DIMAANDAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3648
Mailing Address - Country:US
Mailing Address - Phone:860-358-5970
Mailing Address - Fax:860-358-8690
Practice Address - Street 1:80 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3648
Practice Address - Country:US
Practice Address - Phone:860-358-5970
Practice Address - Fax:860-358-8690
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT725322084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology