Provider Demographics
NPI:1154320885
Name:DEROSA, ROBERT T (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:DEROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 SEAGATE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1964
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:5700 MONROE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2767
Practice Address - Country:US
Practice Address - Phone:419-473-6622
Practice Address - Fax:419-473-6627
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35056097207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0786841Medicaid
OH00996OtherPARAMOUNT
OHANTHEMOther000000141262
OH160041509OtherRRMC
OH2083365OtherAETNA
OH07-01542OtherUHC
OH2083365OtherAETNA
OH0786841Medicaid