Healthcare Provider Details

I. General information

NPI: 1659861839
Provider Name (Legal Business Name): RACHEL LYNN DELOST DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 NILES CORTLAND RD SE
WARREN OH
44484-3043
US

IV. Provider business mailing address

111 NEW HAMPSHIRE AVE STE 2
PORTSMOUTH NH
03801-2864
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-8760
  • Fax: 330-469-9706
Mailing address:
  • Phone: 802-909-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34.015757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: