Provider Demographics
NPI:1821287541
Name:ROSANNE M DILAURO, M.D.
Entity Type:Organization
Organization Name:ROSANNE M DILAURO, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-929-3451
Mailing Address - Street 1:739 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1044
Mailing Address - Country:US
Mailing Address - Phone:330-929-7002
Mailing Address - Fax:330-929-4960
Practice Address - Street 1:739 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1044
Practice Address - Country:US
Practice Address - Phone:330-929-7002
Practice Address - Fax:330-929-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0557428Medicaid
OH0557428Medicaid