Healthcare Provider Details

I. General information

NPI: 1669906426
Provider Name (Legal Business Name): KELLY NOEL ROUSH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1062
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1062
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number34.014483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: