Provider Demographics
NPI:1760426357
Name:DIMOTSIS, DEAN V (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:V
Last Name:DIMOTSIS
Suffix:
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 1:15 PRATTS RUN
Mailing Address - Street 2:#105
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-6606
Mailing Address - Country:US
Mailing Address - Phone:540-946-9177
Mailing Address - Fax:
Practice Address - Street 1:15 PRATTS RUN
Practice Address - Street 2:#105
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6606
Practice Address - Country:US
Practice Address - Phone:540-946-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000371213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336330620Medicaid
VA1588847982OtherNPI GROUP LEXINGTON
VA1336330620OtherVIRGINIA PREMIER
VA1336330620OtherVIRGINIA HEALTH NETWORK
VA1336330620OtherSOUTHERN HEALTH
VA283489OtherANTHEM
1336330620OtherGROUP NPI
VA1760426357OtherNPI
VAC10346OtherMEDICARE GROUP PIN
VA035371OtherANTHEM
VAP00444410OtherRAILROAD MEDICARE PIN
VADG6187OtherRAILROAD MEDICARE GROUP
VA6011470002Medicare NSC
VA1588847982OtherNPI GROUP LEXINGTON
VADG6187OtherRAILROAD MEDICARE GROUP
VAT21532Medicare UPIN