Healthcare Provider Details

I. General information

NPI: 1407856131
Provider Name (Legal Business Name): ROSEMARY DE ANGELIS LAIRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SPYGLASS CT STE 501
VIERA FL
32940-8288
US

IV. Provider business mailing address

7000 SPYGLASS CT STE 501S
VIERA FL
32940-8288
US

V. Phone/Fax

Practice location:
  • Phone: 321-247-7063
  • Fax: 866-422-6264
Mailing address:
  • Phone: 321-247-7063
  • Fax: 866-422-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME85100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: