Provider Demographics
NPI:1124081799
Name:ROSHAL, ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:ROSHAL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 ENTRANCE WAY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1645
Practice Address - Country:US
Practice Address - Phone:636-916-9920
Practice Address - Fax:636-916-9176
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057442A207RH0003X, 207RX0202X
MO2005028007207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207394602Medicaid
ILENROLLEDMedicaid
MO936520183Medicare PIN