Healthcare Provider Details

I. General information

NPI: 1669479531
Provider Name (Legal Business Name): FREDERICK DIMEO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S BAY RD STE 1F
DOVER DE
19901-4694
US

IV. Provider business mailing address

640 S STATE ST POB BLDG--3RD FLOOR
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-730-4366
  • Fax: 302-730-0231
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-257-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC50000194
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC50000194
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: