Healthcare Provider Details

I. General information

NPI: 1154536944
Provider Name (Legal Business Name): ROSEMARY L. D'AGOSTINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 PRAY BLVD
WATERVILLE OH
43566-8712
US

IV. Provider business mailing address

1089 PRAY BLVD
WATERVILLE OH
43566-8712
US

V. Phone/Fax

Practice location:
  • Phone: 567-952-2100
  • Fax: 567-952-2101
Mailing address:
  • Phone: 567-952-2100
  • Fax: 567-952-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35059275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: