Provider Demographics
NPI:1427146208
Name:DINICOLA, WILLIAM F (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:DINICOLA
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 1:300 OLD RIVER RD
Mailing Address - Street 2:125
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9503
Mailing Address - Country:US
Mailing Address - Phone:661-663-3122
Mailing Address - Fax:
Practice Address - Street 1:300 OLD RIVER RD
Practice Address - Street 2:125
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9503
Practice Address - Country:US
Practice Address - Phone:661-663-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG172102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40017Medicare UPIN