Provider Demographics
NPI:1851378897
Name:ROSZKOWSKA, JOLANTA E (MD)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:E
Last Name:ROSZKOWSKA
Suffix:
Gender:F
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:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:MS
Mailing Address - Zip Code:39359-0150
Mailing Address - Country:US
Mailing Address - Phone:601-625-7140
Mailing Address - Fax:601-625-7199
Practice Address - Street 1:1488 HWY 487
Practice Address - Street 2:
Practice Address - City:SEBASTOPAL
Practice Address - State:MS
Practice Address - Zip Code:39359
Practice Address - Country:US
Practice Address - Phone:601-625-7140
Practice Address - Fax:601-625-7199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16539207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00015210OtherRAILROAD MEDICARE
MS00121829Medicaid
G89742Medicare UPIN