Provider Demographics
NPI:1962478925
Name:ROZIN, ELLA (MD)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:ROZIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HIGHWAY K
Mailing Address - Street 2:SUITE 4
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-8423
Mailing Address - Country:US
Mailing Address - Phone:636-240-9896
Mailing Address - Fax:636-240-2799
Practice Address - Street 1:1001 HIGHWAY K
Practice Address - Street 2:SUITE 4
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-8423
Practice Address - Country:US
Practice Address - Phone:636-240-9896
Practice Address - Fax:636-240-2799
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO109843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27298Medicare UPIN