Provider Demographics
NPI:1972602423
Name:DIMARIO, RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DIMARIO
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:CAPE NEDDICK
Mailing Address - State:ME
Mailing Address - Zip Code:03902-0186
Mailing Address - Country:US
Mailing Address - Phone:207-363-4224
Mailing Address - Fax:207-363-1425
Practice Address - Street 1:1 BRICKYARD LANE
Practice Address - Street 2:UNIT A
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-363-4224
Practice Address - Fax:207-363-1425
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD143213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME600555Medicare PIN
T31653Medicare UPIN