=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255332243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID DANIEL DILORETO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 02/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 E THOM ST
-----------------------------------------------------
City | CHINA GROVE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28023-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-855-8338
-----------------------------------------------------
Fax | 704-855-8339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 602362
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-2362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-855-8338
-----------------------------------------------------
Fax | 704-855-8339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 37819
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------