Provider Demographics
NPI:1871704627
Name:LAROSA, DAVID F (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:LAROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 ARK RD STE 103B
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3190
Mailing Address - Country:US
Mailing Address - Phone:856-372-5600
Mailing Address - Fax:609-308-3742
Practice Address - Street 1:822 PINE ST STE 1D
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:215-922-5080
Practice Address - Fax:215-413-2237
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09085000207K00000X
PAMD421039207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157665EJ7Medicare PIN
PA157865G55Medicare PIN
NJ244548DSCMedicare PIN