Individual
MR. MARIO KLIMENTOV DIMITROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5401 OLD COURT ROAD, NORTHWEST HOSPITAL CENTER, RANDALLSTOWN, MD 21133
(410) 521-2200
Mailing address
5401 OLD COURT RD, ATTN: CREDENTIALING, RANDALLSTOWN, MD 21133-5103
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0002204
MD
Other
Enumeration date
07/24/2006
Last updated
07/08/2007
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