Provider Demographics
NPI:1467576199
Name:DIBONA, DEE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:ELLEN
Last Name:DIBONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 COINBOW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-2503
Mailing Address - Country:US
Mailing Address - Phone:843-971-4157
Mailing Address - Fax:
Practice Address - Street 1:4115 DORCHESTER RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7501
Practice Address - Country:US
Practice Address - Phone:843-554-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17988207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9295Medicare PIN
SCG804369295Medicare UPIN
SCG80436Medicare UPIN