Healthcare Provider Details

I. General information

NPI: 1295719680
Provider Name (Legal Business Name): ALLEN J ROVNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW RADIOLOGY ASSOCIATES OF CANTON, INC
CANTON OH
44710-1702
US

IV. Provider business mailing address

P.O. BOX 72384 RADIOLOGY ASSOCIATES OF CANTON, INC.
CLEVELAND OH
44192
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-2842
  • Fax: 330-580-5536
Mailing address:
  • Phone: 888-686-1837
  • Fax: 330-686-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number35 040766
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number35 040766
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35 040766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: