Provider Demographics
NPI:1154536944
Name:D'AGOSTINO, ROSEMARY L (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:L
Last Name:D'AGOSTINO
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 1:1089 PRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-8712
Mailing Address - Country:US
Mailing Address - Phone:567-952-2100
Mailing Address - Fax:567-952-2101
Practice Address - Street 1:1089 PRAY BLVD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-8712
Practice Address - Country:US
Practice Address - Phone:567-952-2100
Practice Address - Fax:567-952-2101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35059275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35059275OtherOHIO LICENSE