MEDICARE: DR. GREGORY RAYMOND DELOST D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	34.013691	OH

General Provider Information

NPI Number	:	1073995791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY RAYMOND DELOST D.O.

Provider Business Mailing Address
First Line	:	130 LAKESHORE DR
Second Line	:
City	:	STRUTHERS
State	:	OH
Zip	:	44471-1454
Country	:	US
Telephone Number	:	330-720-4259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 LANDERBROOK DR STE 250
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4047
Country	:	US
Telephone Number	:	440-646-1600
Fax Number	:	440-646-1505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	09/01/2022

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