Provider Demographics
NPI:1568464816
Name:DIPRETORO, RAYMOND A JR (DPM)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:DIPRETORO
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 CHRISTIANA RD
Mailing Address - Street 2:STE 105
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4236
Mailing Address - Country:US
Mailing Address - Phone:302-623-4250
Mailing Address - Fax:302-623-4252
Practice Address - Street 1:774 CHRISTIANA RD
Practice Address - Street 2:STE 105
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-623-4250
Practice Address - Fax:302-623-4252
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1000090213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000234317OtherDELAWARE PHYSICIANS CARE
1144087OtherCIGNA
0430506000OtherAMERIHEALTH/KEYSTONE/PC
DE226168OtherUNISON
349964OtherMAMSI/OPTIMUM CHOICE
5084OtherELDER HEALTH
DEU05931OtherBCBS
DE0000234317Medicaid
43816OtherCOVENTRY
2700771OtherUNITED HEALTHCARE
4331907OtherAETNA
2700771OtherUNITED HEALTHCARE
480028766Medicare ID - Type UnspecifiedRAILROAD MEDICARE
000M10A86Medicare ID - Type Unspecified