Healthcare Provider Details

I. General information

NPI: 1912967878
Provider Name (Legal Business Name): DAVID ROBERT DELLIQUADRI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E LIBERTY ST
GIRARD OH
44420
US

IV. Provider business mailing address

116 E LIBERTY ST
GIRARD OH
44420
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-8643
  • Fax: 330-545-6557
Mailing address:
  • Phone: 330-545-8643
  • Fax: 330-545-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: