Provider Demographics
NPI:1548324270
Name:DIMARIA, VINCENT A (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:DIMARIA
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 1:7780 S BROADWAY
Mailing Address - Street 2:220
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2648
Mailing Address - Country:US
Mailing Address - Phone:303-795-2345
Mailing Address - Fax:303-795-1003
Practice Address - Street 1:7780 S BROADWAY
Practice Address - Street 2:220
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2648
Practice Address - Country:US
Practice Address - Phone:303-795-2345
Practice Address - Fax:303-795-1003
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics