Healthcare Provider Details

I. General information

NPI: 1295909174
Provider Name (Legal Business Name): GREGORY DANTE ROULETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 UNIVERSITY DR
WEST CHESTER OH
45069-2505
US

IV. Provider business mailing address

525 E MARKET ST MEDICAL BUILDING, 2ND FLOOR
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8248
  • Fax: 513-475-8468
Mailing address:
  • Phone: 330-375-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD440660
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35.122055
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.122055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: