Healthcare Provider Details

I. General information

NPI: 1962936096
Provider Name (Legal Business Name): ELENA ANN ROUMAYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 06/13/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42024 AL-195
HALEYVILLE AL
35565
US

IV. Provider business mailing address

6544 SILVIO ST
GARDEN CITY MI
48135-1631
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-5213
  • Fax:
Mailing address:
  • Phone: 734-674-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48539
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61637
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: