Provider Demographics
NPI:1558454108
Name:D'AMORE, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:D'AMORE
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 1:7264 WARREN SHARON ROAD P.O. BOX 269
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44403
Mailing Address - Country:US
Mailing Address - Phone:330-448-7800
Mailing Address - Fax:330-448-7747
Practice Address - Street 1:7264 WARREN SHARON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9691
Practice Address - Country:US
Practice Address - Phone:330-448-7800
Practice Address - Fax:330-448-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-1155 D207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009854280004Medicaid
OH0570412Medicaid
PA0009854280004Medicaid
PA016280Medicare ID - Type Unspecified
OH0477163Medicare ID - Type Unspecified