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NPI Code Detail

MEDICARE: CAROL DIMOND MD

MEDICARE: CAROL DIMOND 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
1207R00000XInternal Medicine Physician155797NY

Other Identifiers

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

General Provider Information

NPI Number : 1508904103
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL DIMOND MD
Provider Business Mailing Address
First Line : 2445 STATE ROUTE 30
Second Line : SUNMOUNT DDSO
City : TUPPER LAKE
State : NY
Zip : 12986-2502
Country : US
Telephone Number : 518-359-7701
Fax Number : 518-359-4133
Provider Business Practice Location Address
First Line : 2445 STATE ROUTE 30
Second Line : SUNMOUNT DDSO
City : TUPPER LAKE
State : NY
Zip : 12986-2502
Country : US
Telephone Number : 518-359-7701
Fax Number : 518-359-4133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2007
Last Update Date : 07/20/2010

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