Basic Information
| Provider Information | |||||||||
| NPI: | 1265479463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIMARCO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 SAINT ANDREWS DR | ||||||||
| Address2: | |||||||||
| City: | BELLEAIR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274555416 | ||||||||
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| Practice Location | |||||||||
| Address1: | 603 7TH ST S | ||||||||
| Address2: | STE 590 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274414581 | ||||||||
| FaxNumber: | 7274432307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | ME40032 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 022196000 | 05 | FL | MEDICAID |