Healthcare Provider Details

I. General information

NPI: 1609879196
Provider Name (Legal Business Name): ELIZABETH ANN ROSEBERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 EAGLE PASS DR
MARION OH
43302-8138
US

IV. Provider business mailing address

1446 EAGLE PASS DR
MARION OH
43302-8138
US

V. Phone/Fax

Practice location:
  • Phone: 740-382-3511
  • Fax: 740-382-0682
Mailing address:
  • Phone: 740-382-3511
  • Fax: 740-382-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.079875
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.079875
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35079875
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: