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General NPI Number Information
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NPI Number | 1942344387
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY ASSOCIATES OF OHIO, LLC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3694 STARRS CENTRE DR
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City | CANFIELD
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State | OH
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Zip | 44406-9514
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Country | US
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Telephone | 330-702-1310
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Fax |
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Provider Business Mailing Address
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Address Line | 3694 STARRS CENTRE DR
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City | CANFIELD
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State | OH
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Zip | 44406-9514
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Country | US
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Telephone | 330-702-1310
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | MICHAEL DEROSA
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Credential | D.O.
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Telephone | 330-702-1310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 34008028D
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License Number State | OH
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