MR. MARIO KLIMENTOV DIMITROV (NPI# 1013939255) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013939255 |
| Entity Type | Individual |
| Full Name | MR. MARIO KLIMENTOV DIMITROV |
| Credential | PA-C |
| Practice Address |
5401 Old Court Road Northwest Hospital Center Randallstown MD 21133 |
| Mailing Address |
5401 Old Court Rd Attn: Credentialing Randallstown MD 21133-5103 |
| Practice Telephone | 4105212200 |
| Mailing Telephone | 4106015524 |
| Mailing Fax Number | 4106018946 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
C0002204 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5401 OLD COURT ROAD NORTHWEST HOSPITAL CENTER |
| City | RANDALLSTOWN |
| State | MD |
| Zip Code | 21133 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417993205 | Lisa M Quarles | Physician Assistant | 5401 Old Court Road, Northwest Hospital, Randallstown, MD 21133 | 2006-06-21 |
| 1669038436 | Julie Radnoff | Physical Therapist | 5401 Old Court Road, Randallstown, MD 21133 | 2019-05-16 |
| 1508291410 | Kristy Michelle Fogle | Physician Assistant | 5401 Old Court Road, Northwest Hospital-emergency Department, Randallstown, MD 21133 | 2013-09-10 |
| 1770648370 | Thomas J Krisanda | Emergency Medicine | 5401 Old Court Road, Northwest Hospital Emergency Dept., Randallstown, MD 21133 | 2006-12-26 |
| 1710083241 | Mayer Gorbaty | Internal Medicine | 5401 Old Court Road, Northwest Hospital, Randallstown, MD 21133 | 2006-09-15 |
| 1538181888 | Kathleen A Ryan | Physician Assistant | 5401 Old Court Road, Northwest Hospital Center, Randallstown, MD 21133 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649898313 | Olivia David | Registered Nurse | 3525 Liberty Resource Drive, Randallstown, MD 21133 | 2020-07-09 |
| 1366082547 | Jerry Njomgert Christopher | Home Health Aide | 9106 Sandra Ct. Randallstown, Randallstown, MD 21133 | 2020-01-15 |
| 1487138913 | For Hope's Sake, LLC | Substance Abuse Rehabilitation Facility | 9905 Southhall Road, Randallstown, MD 21133 | 2018-09-20 |
| 1295214393 | Levindale Hebrew Geriatric Center & Hospital Inc | Clinic/Center | Lifebridge Health Adult Day Services, 5400 Old Court Road, Randallstown, MD 21133 | 2018-08-09 |
| 1235623968 | Away of Change Counseling Service, LLC | Counselor | 5310 Old Court Rd Ste 304, Randallstown, MD 21133 | 2018-06-16 |
| 1922503382 | Top Care Residential Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8607 Liberty Rd, Randallstown, MD 21133 | 2018-03-28 |
| 1497274880 | Yushika M Shepherd | In Home Supportive Care | 8911 Allenswood Rd, Randallstown, MD 21133 | 2017-09-17 |
| 1790208718 | Productive Lives Mental Health, LLC | Clinic/Center | Randallstown Medical Center 5310 Old Court Rd Suite 308, Randallstown, MD 21133 | 2017-07-21 |
| 1982136198 | Marla Rosanne Yee | Dentist | 5415 Old Court Road, Suite 01, Randallstown, MD 21133 | 2017-03-28 |
| 1598203549 | Traci Harris | Social Worker | 9633 Liberty Rd. (suites H&j), Randallstown, MD 21133 | 2017-02-09 |
| Find all providers in zip 21133 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376510693 | Dorothy Ranson Outten | Physician Assistant | Lifeline Urgent Care of Randallstown, 8507 Liberty Road, Randallstown, MD 21133 | 2006-03-06 |
| 1518485002 | Binh Van Cao | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2017-09-05 |
| 1538512751 | Pierre Guy Daze | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2016-07-22 |
| 1710348388 | Zainab Kamara | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2016-03-10 |
| 1366816316 | Bethany Rohrs | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2015-11-13 |
| 1104228568 | Bethany Kate Heaton | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2014-09-17 |
| 1871992495 | Kristin Powell | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2014-08-19 |
| 1295134187 | Shannon Keohane | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2014-08-18 |
| 1235552274 | Daniel Tsige Tamerat | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2014-01-28 |
| 1679995674 | Mike Destine | Physician Assistant | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2014-01-09 |
| Find all providers in RANDALLSTOWN | ||||
| City | RANDALLSTOWN |
| Zip Code | 21133 |
Please comment or provide details below to improve the information on MR. MARIO KLIMENTOV DIMITROV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.