Healthcare Provider Details

I. General information

NPI: 1962464479
Provider Name (Legal Business Name): DIMARINO-KROOP-PRIETO GASTROINTESTINAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S 10TH ST 480 MAIN BUILDING
PHILA PA
19107-5244
US

IV. Provider business mailing address

132 S 10TH ST 480 MAIN BUILDING
PHILA PA
19107-5244
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax: 215-955-5245
Mailing address:
  • Phone: 215-955-8900
  • Fax: 215-955-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIAN LAMPMAN
Title or Position: BILLING MANAGER
Credential:
Phone: 215-955-3947