Healthcare Provider Details

I. General information

NPI: 1225553217
Provider Name (Legal Business Name): ANDREA LYNNE DIMAIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLAZA SUITE 307
CAMDEN NJ
08103
US

IV. Provider business mailing address

1 COOPER PLAZA
CAMDEN NJ
08103
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2328
  • Fax:
Mailing address:
  • Phone: 856-342-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB10205800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: