Healthcare Provider Details

I. General information

NPI: 1386692325
Provider Name (Legal Business Name): PAUL PETER DIMARTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE BOX T6-7
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

1542 TULANE AVE BOX T6-7
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4680
  • Fax: 504-568-4466
Mailing address:
  • Phone: 504-568-4680
  • Fax: 504-568-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number204973
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: