Provider Demographics
NPI:1700062460
Name:RICHARD DIMARIO PA
Entity Type:Organization
Organization Name:RICHARD DIMARIO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-363-4224
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 LN
Practice Address - Street 2:UNIT A
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1604
Practice Address - Country:US
Practice Address - Phone:207-363-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD143213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0894020001Medicare NSC
MET31653Medicare UPIN
ME600555Medicare PIN