Provider Demographics
NPI:1386692325
Name:DIMARTINO, PAUL PETER (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:PETER
Last Name:DIMARTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 TULANE AVE
Mailing Address - Street 2:BOX T6-7
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2865
Mailing Address - Country:US
Mailing Address - Phone:504-568-4680
Mailing Address - Fax:504-568-4466
Practice Address - Street 1:1542 TULANE AVE
Practice Address - Street 2:BOX T6-7
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-568-4680
Practice Address - Fax:504-568-4466
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204973207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0491953OtherCIGNA
VA13765OtherSENTARA-OPTIMA HEALTH
VA54-1739189OtherFED TAX ID
VA0900797OtherUNITED HEALTHCARE
VA19706OtherCARENET-MEDICAID
VA258231OtherMDIPA,MAMSI,OPTIMUM CHOIC
VA08936187200OtherOHIO WORK COMP
VA1005877OtherUS HEALTHCARE-AETNA HMO
VA107537OtherANTHEM BC/BS
VA4023216OtherAETNA
VA006405631Medicaid
VA150146600OtherUS DEPT OF LABOR
VA83299OtherSOUTHERN HEALTH
VA200028970Medicare ID - Type UnspecifiedMEDICARE-RAILROAD
VA200000962Medicare ID - Type Unspecified
VA006405631Medicaid