Provider Demographics
NPI:1821346651
Name:EDWARD DIPRETA,MD, P.C.
Entity Type:Organization
Organization Name:EDWARD DIPRETA,MD, P.C.
Other - Org Name:DIPRETA DERMATOLOGY DISPENSARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIPRETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-265-2142
Mailing Address - Street 1:3008 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4241
Mailing Address - Country:US
Mailing Address - Phone:912-265-2142
Mailing Address - Fax:912-265-0530
Practice Address - Street 1:370 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0244
Practice Address - Country:US
Practice Address - Phone:912-427-4344
Practice Address - Fax:912-427-4303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD DIPRETA,MD.P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052707332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site