Provider Demographics
NPI:1487725743
Name:DIMARCO, KRISTEN ROSE (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ROSE
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE ROAD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-738-6565
Mailing Address - Fax:401-738-6599
Practice Address - Street 1:215 TOLL GATE ROAD
Practice Address - Street 2:SUITE 306
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-6565
Practice Address - Fax:401-738-6599
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO0503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2900OtherNHP
9002776OtherEDS
5343699003OtherCIGNA P A L
RI503OtherLIFESPAN
005030OtherTUFTS
0101365OtherUHC
DOOO503OtherLICENSE NUMBER
222482OtherBLUE CROSS
405535OtherBLUE CHIP
405535OtherBLUE CHIP
0101365OtherUHC
5343699003OtherCIGNA P A L