Healthcare Provider Details

I. General information

NPI: 1659812865
Provider Name (Legal Business Name): MARIA LAURA COSENTINO ROA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA LAURA COSENTINO MD

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE K201
LEXINGTON KY
40536-1005
US

IV. Provider business mailing address

16445 COLLINS AVE 221
SUNNY ISLES BEACH FL
33160-4555
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2509
  • Fax: 859-323-3499
Mailing address:
  • Phone: 954-881-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number57803
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: