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General NPI Number Information
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NPI Number | 1962542829
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Entity Type | Organization
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Legal Business Name | KRISTEN R. DIMARCO, DO LTD
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 TOLL GATE RD SUITE 306
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City | WARWICK
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State | RI
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Zip | 02886-4458
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Country | US
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Telephone | 401-738-6565
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Fax | 401-738-6599
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Provider Business Mailing Address
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Address Line | 215 TOLL GATE RD SUITE 306
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City | WARWICK
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State | RI
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Zip | 02886-4458
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Country | US
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Telephone | 401-738-6565
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Fax | 401-738-6599
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. MICHAEL RICHARD MARTIN
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Credential | DO
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Telephone | 401-738-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00503
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License Number State | RI
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