Provider Demographics
NPI:1922002393
Name:DIMARCO, ANTONINO TANO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONINO
Middle Name:TANO
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:7901 ROME WESTERNVILLE RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2203
Practice Address - Country:US
Practice Address - Phone:315-624-9000
Practice Address - Fax:315-624-9003
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2020-09-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NY134503207RC0000X
NY134503-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00534905Medicaid
NYB81649Medicare UPIN
NY00534905Medicaid