Stephanie Dimos, MS, ATC
Individual provider Active NPI Specialist · Bear, DE
NPI 1487054565 · NPPES record last updated Aug 26, 2014
Key facts
- NPI
- 1487054565
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- J3-0000407 (DE)
- Practice address
- 5102 Christiana MDWS
Bear, DE 19701-1156 - Phone
- (330) 310-1180
- NPI assigned
- Aug 26, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J3-0000407 | DE | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | J3-0000407 | DE | Yes |
Addresses
Primary practice location
5102 Christiana MDWS
Bear, DE 19701-1156
Mailing address
5102 Christiana MDWS
Bear, DE 19701-1156
Phone (330) 310-1180
Other providers in Bear, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.