Provider Demographics
NPI:1235143025
Name:DELAURENTIS, DINO A (DO)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:A
Last Name:DELAURENTIS
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 1:787 WEATHERLY DR
Mailing Address - Street 2:400
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8952
Mailing Address - Country:US
Mailing Address - Phone:931-291-9150
Mailing Address - Fax:931-291-9102
Practice Address - Street 1:787 WEATHERLY DR
Practice Address - Street 2:400
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8952
Practice Address - Country:US
Practice Address - Phone:931-291-9150
Practice Address - Fax:931-291-9102
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008615208800000X
IL036-106625208800000X
TNDO00000021432088P0231X
TN2143208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology