Provider Demographics
NPI:1023100476
Name:DI LAURO, CYNTHIA L (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:DI LAURO
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 1:555 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-6312
Mailing Address - Country:US
Mailing Address - Phone:970-577-4490
Mailing Address - Fax:970-586-4960
Practice Address - Street 1:555 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-6312
Practice Address - Country:US
Practice Address - Phone:970-577-4490
Practice Address - Fax:970-586-4960
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0035775207R00000X
OH35060706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F25179Medicare UPIN
DI 0714331Medicare ID - Type Unspecified