Provider Demographics
NPI:1003848292
Name:DIMARTINO, NICHOLAS (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:DIMARTINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5724 CLYMER RD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-3266
Mailing Address - Country:US
Mailing Address - Phone:215-536-1890
Mailing Address - Fax:215-529-9034
Practice Address - Street 1:5724 CLYMER RD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-3266
Practice Address - Country:US
Practice Address - Phone:215-536-1890
Practice Address - Fax:215-529-9034
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF90658Medicare UPIN