Provider Demographics
NPI:1902837321
Name:RIDGE MILLS PHYSICIAN SERVICES, PLLC
Entity Type:Organization
Organization Name:RIDGE MILLS PHYSICIAN SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:315-337-2500
Mailing Address - Street 1:7845 ROME WESTERNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2202
Mailing Address - Country:US
Mailing Address - Phone:315-337-2500
Mailing Address - Fax:855-667-1414
Practice Address - Street 1:7845 ROME WESTERNVILLE RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2202
Practice Address - Country:US
Practice Address - Phone:315-337-2500
Practice Address - Fax:855-667-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0250Medicare ID - Type Unspecified