Provider Demographics
NPI:1477517480
Name:ROIZEN, NANCY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:ROIZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:MRAZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-844-3230
Mailing Address - Fax:
Practice Address - Street 1:10524 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2205
Practice Address - Country:US
Practice Address - Phone:216-844-3230
Practice Address - Fax:216-201-5188
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350866722080P0006X
OH35-0866722080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001919700005Medicaid
OH2629687Medicaid
OHA89474Medicare UPIN
OHR04213821Medicare PIN
PA001919700005Medicaid