Provider Demographics
NPI:1265873194
Name:DIPAOLO, ZACHARY
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:DIPAOLO
Suffix:
Gender:M
Credentials:
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7900
Mailing Address - Fax:843-777-7925
Practice Address - Street 1:1005 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2707
Practice Address - Country:US
Practice Address - Phone:843-777-7900
Practice Address - Fax:843-777-7925
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57023593207X00000X
MO2017041099207X00000X
SC82388207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC823880Medicaid