Provider Demographics
NPI:1710950811
Name:DANIELSON, ROSANNE M (MD)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:M
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:DANIELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2830 VICTORY PARKWAY
Mailing Address - Street 2:PAYOR ENROLLMENT
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-585-5507
Mailing Address - Fax:
Practice Address - Street 1:7675 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2509
Practice Address - Country:US
Practice Address - Phone:513-475-7505
Practice Address - Fax:513-475-8898
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.124146CTR207RG0100X
MI4301097729207RG0100X
MT12680207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106831Medicaid
OHH344610Medicare PIN
H24779Medicare UPIN