Provider Demographics
NPI:1073995791
Name:DELOST, GREGORY RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RAYMOND
Last Name:DELOST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1454
Mailing Address - Country:US
Mailing Address - Phone:330-720-4259
Mailing Address - Fax:
Practice Address - Street 1:5800 LANDERBROOK DR STE 250
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4047
Practice Address - Country:US
Practice Address - Phone:440-646-1600
Practice Address - Fax:440-646-1505
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013691207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology