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NPI Code Detail

MEDICARE: DR. TINA MARIE D'AMATO D.O.

MEDICARE: DR. TINA MARIE D'AMATO D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician032-0000547VT

General Provider Information

NPI Number : 1902957020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TINA MARIE D'AMATO D.O.
Provider Business Mailing Address
First Line : 75 SAN REMO DR
Second Line : 204
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6385
Country : US
Telephone Number : 802-658-9440
Fax Number : 802-658-9443
Provider Business Practice Location Address
First Line : 75 SAN REMO DR
Second Line : 204
City : SOUTH BURLINGTON
State : VT
Zip : 05403-6385
Country : US
Telephone Number : 802-658-9440
Fax Number : 802-658-9443
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 11/15/2016

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