Provider Demographics
NPI:1346330131
Name:PALERMO, ROSANNE M (DMD)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:M
Last Name:PALERMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 WEST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3661
Mailing Address - Country:US
Mailing Address - Phone:814-833-3001
Mailing Address - Fax:814-833-4886
Practice Address - Street 1:3437 WEST LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3661
Practice Address - Country:US
Practice Address - Phone:814-833-3001
Practice Address - Fax:814-833-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027193L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02226Medicare UPIN
PA613291Medicare ID - Type Unspecified