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EDWARD A DIPRETA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3008 E PARK AVE, BRUNSWICK, GA 31520-4241
(912) 265-2142
(912) 265-0530
Mailing address
3008 E PARK AVE, BRUNSWICK, GA 31520-4241
(912) 265-2142
(912) 265-0530

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
052707
GA
207ND0101X
MOHS-Micrographic Surgery Physician
052707
GA
207ND0900X
Dermatopathology Physician
052707
GA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
052707
GA
207NP0225X
Pediatric Dermatology Physician
052707
GA
207NS0135X
Procedural Dermatology Physician
052707
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
487177354
GA
01
52046337012
BCBS (GA DERM)
GA
01
52046337014
BCBS (BWKDERM)
GA
01
DC4061
RAILROAD MEDICARE
GA
01
P00182483
RAILROAD MEDICARE
GA
Enumeration date
11/15/2005
Last updated
02/13/2008
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