Provider Demographics
NPI:1174500383
Name:ROSHON, STEVEN GALE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GALE
Last Name:ROSHON
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 1:417 QUARRY LAKES DR.
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4132
Mailing Address - Country:US
Mailing Address - Phone:419-626-9090
Mailing Address - Fax:419-626-6319
Practice Address - Street 1:417 QUARRY LAKES DR.
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4132
Practice Address - Country:US
Practice Address - Phone:419-626-9090
Practice Address - Fax:419-626-6319
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044393R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110040853OtherRAILROAD MEDICARE
OH514269Medicaid
OH03540OtherPARAMOUNT
OH000000128757OtherANTHEM
OH68543877-001OtherMEDICAL MUTUAL OF OHIO
OHRO0542192OtherMEDICARE PROVIDER #
OH68543877-001OtherMEDICAL MUTUAL OF OHIO