MEDICARE: DAVID DANIEL DILORETO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	37819	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28307	OTHER	NC	BLUE CROSS BLUE SHIELD NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255332243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DANIEL DILORETO MD

Provider Business Mailing Address
First Line	:	PO BOX 602362
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2362
Country	:	US
Telephone Number	:	704-855-8338
Fax Number	:	704-855-8339

Provider Business Practice Location Address
First Line	:	307 E THOM ST
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2363
Country	:	US
Telephone Number	:	704-855-8338
Fax Number	:	704-855-8339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/15/2013

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