MEDICARE: GINO DIVITTORIO M.D.

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	207RR0500X	Rheumatology Physician	00009491	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366456295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINO DIVITTORIO M.D.

Provider Business Mailing Address
First Line	:	6701 AIRPORT BLVD STE A 101
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-6767
Country	:	US
Telephone Number	:	251-633-8880
Fax Number	:	251-378-6222

Provider Business Practice Location Address
First Line	:	75 S UNIVERSITY BLVD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36608-3271
Country	:	US
Telephone Number	:	251-660-5787
Fax Number	:	251-460-7923

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/25/2022

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