MEDICARE: DR. ROSEMARY DE ANGELIS LAIRD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME85100	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5X271	OTHER		FLORIDA BLUE
2	1563738	OTHER		CIGNA

General Provider Information

NPI Number	:	1407856131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSEMARY DE ANGELIS LAIRD MD

Provider Business Mailing Address
First Line	:	7000 SPYGLASS CT STE 501S
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-247-7063
Fax Number	:	866-422-6264

Provider Business Practice Location Address
First Line	:	7000 SPYGLASS CT STE 501
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-247-7063
Fax Number	:	866-422-6264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/14/2023

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