Provider Demographics
NPI:1750832812
Name:DIMAURO, CRYSTAL (PA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DIMAURO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 LIMESTONE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5413
Mailing Address - Country:US
Mailing Address - Phone:302-655-9494
Mailing Address - Fax:302-691-1478
Practice Address - Street 1:3401 BRANDYWINE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1554
Practice Address - Country:US
Practice Address - Phone:302-655-9494
Practice Address - Fax:302-691-1478
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001097363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical