Healthcare Provider Details

I. General information

NPI: 1255332243
Provider Name (Legal Business Name): DAVID DANIEL DILORETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E THOM ST
CHINA GROVE NC
28023-2363
US

IV. Provider business mailing address

PO BOX 602362
CHARLOTTE NC
28260-2362
US

V. Phone/Fax

Practice location:
  • Phone: 704-855-8338
  • Fax: 704-855-8339
Mailing address:
  • Phone: 704-855-8338
  • Fax: 704-855-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37819
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: