Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 01057442A | IN |
N | 207RX0202X | Medical Oncology | 2005028007 | MO |
NPI | 1124081799 |
---|---|
Provider Name | Dr. Anna Roshal |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Saint Peters, MO 63376-1645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207394602 | (05) | MO |
ENROLLED | (05) | IL |