=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568464816
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND A DIPRETORO JR. DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 01/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 774 CHRISTIANA RD STE 105
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-623-4250
-----------------------------------------------------
Fax | 302-623-4252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 774 CHRISTIANA RD STE 105
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713-4236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-623-4250
-----------------------------------------------------
Fax | 302-623-4252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | E1000090
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------