Provider Demographics
NPI:1770531212
Name:ROSEL, PAUL R (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:ROSEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1675 E MAIN ST
Mailing Address - Street 2:BOX 328
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-5818
Mailing Address - Country:US
Mailing Address - Phone:330-593-1030
Mailing Address - Fax:330-677-8770
Practice Address - Street 1:1675 E MAIN ST
Practice Address - Street 2:BOX 328
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-5818
Practice Address - Country:US
Practice Address - Phone:330-593-1030
Practice Address - Fax:330-677-8770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.0938812085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2969590Medicaid
OH2969590Medicaid
OH4267281Medicare PIN