Provider Demographics
NPI:1053406678
Name:ROSACE, REGINA M (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:ROSACE
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 1:24701 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:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0649262080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018515Medicaid
OH745965OtherBUCKEYE
OH000000526093OtherANTHEM
OH2018515OtherBCMH
OH000000027623OtherANTHEM
PA1020967470001OtherPA MEDICAID
OH363965OtherWELLCARE
OH000000221289OtherUNISON
OH801820OtherAETNA
OHG55033Medicare UPIN
PA1020967470001OtherPA MEDICAID
OH2018515Medicaid
OHH099010Medicare PIN