Provider Demographics
NPI:1902957020
Name:D'AMATO, TINA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:D'AMATO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:75 SAN REMO DR
Mailing Address - Street 2:204
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6385
Mailing Address - Country:US
Mailing Address - Phone:802-658-9440
Mailing Address - Fax:802-658-9443
Practice Address - Street 1:75 SAN REMO DR
Practice Address - Street 2:204
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6385
Practice Address - Country:US
Practice Address - Phone:802-658-9440
Practice Address - Fax:802-658-9443
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT032-0000547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine