MEDICARE: EDWARD A DIPRETA MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	052707	GA
2	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	052707	GA
3	207NS0135X	Procedural Dermatology Physician	052707	GA
4	207ND0900X	Dermatopathology Physician	052707	GA
5	207ND0101X	MOHS-Micrographic Surgery Physician	052707	GA
6	207NP0225X	Pediatric Dermatology Physician	052707	GA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC4061	OTHER	GA	RAILROAD MEDICARE
3	P00182483	OTHER	GA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	52046337014	OTHER	GA	BCBS (BWKDERM)
5	52046337012	OTHER	GA	BCBS (GA DERM)

NPI Number	:	1689656720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD A DIPRETA MD

Provider Business Mailing Address
First Line	:	3008 E PARK AVE
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4241
Country	:	US
Telephone Number	:	912-265-2142
Fax Number	:	912-265-0530

Provider Business Practice Location Address
First Line	:	3008 E PARK AVE
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4241
Country	:	US
Telephone Number	:	912-265-2142
Fax Number	:	912-265-0530

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	02/13/2008