Provider Demographics
NPI:1629061312
Name:ONE WORLD FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:ONE WORLD FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-876-2174
Mailing Address - Street 1:6805 ROUTE 9
Mailing Address - Street 2:SUITE 31
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1148
Mailing Address - Country:US
Mailing Address - Phone:845-876-3868
Mailing Address - Fax:845-876-3756
Practice Address - Street 1:2565 ROUTE 212
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2115
Practice Address - Country:US
Practice Address - Phone:845-679-6210
Practice Address - Fax:845-679-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty