Provider Demographics
NPI:1366408510
Name:DELAROSA, KATHERINE D (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:DELAROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8910 PURDUE RD
Mailing Address - Street 2:STE.500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1009 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5302
Practice Address - Country:US
Practice Address - Phone:337-893-3443
Practice Address - Fax:337-893-3439
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060840A207R00000X
LA204859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2309692Medicaid
IN200802630Medicaid
IN200802630Medicaid