Individual provider · Type 1 NPI

Mario Klimentov Dimitrov, PA-C

Medical Physician Assistant · Randallstown, MD

NPI number 1013939255 Active

Practice location

5401 Old Court Road, Northwest Hospital Center
Randallstown, MD 21133

Call (410) 521-2200 Map

Mailing address

5401 Old Court Rd, Attn: Credentialing
Randallstown, MD 21133-5103

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XC0002204 (MD)

Medical Physician Assistant: Definition to come...

10 other providers at this address

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About NPI 1013939255

Mario Klimentov Dimitrov, PA-C's National Provider Identifier is 1013939255, issued on Jul 24, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Randallstown, MD. The record was last updated on Jul 8, 2007.