Healthcare Provider Details

I. General information

NPI: 1922002393
Provider Name (Legal Business Name): ANTONINO TANO DIMARCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date: 03/17/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

7901 ROME WESTERNVILLE RD
ROME NY
13440-2203
US

IV. Provider business mailing address

7845 ROME WESTERNVILLE RD
ROME NY
13440-2202
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-9000
  • Fax: 315-624-9003
Mailing address:
  • Phone: 315-337-2500
  • Fax: 855-667-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number134503
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number134503-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: