Healthcare Provider Details

I. General information

NPI: 1134184104
Provider Name (Legal Business Name): ELLEN S ROME MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # R3
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # R3
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-3566
  • Fax: 216-445-3523
Mailing address:
  • Phone: 216-444-3566
  • Fax: 216-445-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35066489
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number35066489
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: