Provider Demographics
NPI:1255777603
Name:DINITTO, TARA-MARIE (MD)
Entity type:Individual
Prefix:
First Name:TARA-MARIE
Middle Name:
Last Name:DINITTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 82ND PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4614
Mailing Address - Country:US
Mailing Address - Phone:843-497-6348
Mailing Address - Fax:843-497-6351
Practice Address - Street 1:849 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4614
Practice Address - Country:US
Practice Address - Phone:843-497-6348
Practice Address - Fax:843-497-6351
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC830462086S0102X, 208600000X
NY244202390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program