Provider Demographics
NPI:1265688998
Name:DE ROSA, CARLO (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:DE ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4644 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PLACIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33946-2306
Mailing Address - Country:US
Mailing Address - Phone:941-697-1199
Mailing Address - Fax:
Practice Address - Street 1:4644 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:PLACIDA
Practice Address - State:FL
Practice Address - Zip Code:33946-2306
Practice Address - Country:US
Practice Address - Phone:941-697-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090141207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery