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General NPI Number Information
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NPI Number | 1316028665
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Entity Type | Individual
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Provider Name | EDWARD A DEL GROSSO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 1320 W. MAIN STREET
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City | NEWARK
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State | OH
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Zip | 43055-1822
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Country | US
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Telephone | 740-348-4779
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Fax | 740-348-4740
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Provider Business Mailing Address
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Address Line | P.O. BOX 948 2112 CHERRY VALLEY RD.,
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City | NEWARK
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State | OH
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Zip | 43058-0948
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Country | US
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Telephone | 740-522-3774
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Fax | 740-522-2221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35-079067
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License Number State | OH
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