| Doctor Name: | MR. MARIO KLIMENTOV DIMITROV |
| NPI Number: | 1013939255 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | C0002204 |
| Business Practice Address: | 5401 Old Court Road Northwest Hospital Center Randallstown, MD - 21133 |
| Business Phone Number: | 4105212200 |
| Business Fax Number: | |
| Mailing Address: | 5401 Old Court Rd, Attn: Credentialing RANDALLSTOWN |
| State: | MD |
| Postal Code: | 211335103 |
| Phone Number: | 4106015524 |
| Fax Number: | 4106018946 |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C0002204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |