Healthcare Provider Details

I. General information

NPI: 1891951430
Provider Name (Legal Business Name): JEFFREY DAVID ROIZEN M.D. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH & CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104-4399
US

IV. Provider business mailing address

3535 MARKET ST 12TH FLOOR, SUITE 1220 - CHOP DEPT OF MSA
PHILADELPHIA PA
19104-3309
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 215-590-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT192381
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: