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NPI Code Detail

MEDICARE: ETHAN DIGEROLAMO

MEDICARE: ETHAN DIGEROLAMO
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1164353173
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN DIGEROLAMO
Provider Business Mailing Address
First Line : 6102 LAKE BEND DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70820-5326
Country : US
Telephone Number : 719-377-8750
Fax Number :
Provider Business Practice Location Address
First Line : 6102 LAKE BEND DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70820-5326
Country : US
Telephone Number : 719-377-8750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ ETHAN DIGEROLAMO ” Practice Location

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