Healthcare Provider Details

I. General information

NPI: 1932149226
Provider Name (Legal Business Name): ROBERT D DIMAIO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 HADDONFIELD RD
CHERRY HILL NJ
08002-2220
US

IV. Provider business mailing address

400 LAUREL OAK RD STE 105
VOORHEES NJ
08043-4455
US

V. Phone/Fax

Practice location:
  • Phone: 844-542-2273
  • Fax:
Mailing address:
  • Phone: 856-922-9894
  • Fax: 856-922-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB048844
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: