Provider Demographics
NPI:1407856131
Name:LAIRD, ROSEMARY DE ANGELIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:DE ANGELIS
Last Name:LAIRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SPYGLASS CT STE 501S
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8288
Mailing Address - Country:US
Mailing Address - Phone:321-247-7063
Mailing Address - Fax:866-422-6264
Practice Address - Street 1:7000 SPYGLASS CT STE 501
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8288
Practice Address - Country:US
Practice Address - Phone:321-247-7063
Practice Address - Fax:866-422-6264
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85100207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5X271OtherFLORIDA BLUE
1563738OtherCIGNA
FL264480100Medicaid