Provider Demographics
NPI:1962542829
Name:KRISTEN R. DIMARCO, DO LTD
Entity type:Organization
Organization Name:KRISTEN R. DIMARCO, DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-738-6565
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-738-6565
Mailing Address - Fax:401-738-6599
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-738-6565
Practice Address - Fax:401-738-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty