Provider Demographics
NPI:1659812865
Name:COSENTINO ROA, MARIA LAURA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LAURA
Last Name:COSENTINO ROA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LAURA
Other - Last Name:COSENTINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16445 COLLINS AVE
Mailing Address - Street 2:221
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4555
Mailing Address - Country:US
Mailing Address - Phone:954-881-8826
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE K201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1005
Practice Address - Country:US
Practice Address - Phone:859-218-2509
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY578032080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program