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NPI Code Detail

MEDICARE: GREGORY S ROESSER

MEDICARE: GREGORY S ROESSER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor100225OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043703168
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY S ROESSER
Provider Business Mailing Address
First Line : 7540 NEW WEST RD
Second Line :
City : TOLEDO
State : OH
Zip : 43617-4200
Country : US
Telephone Number : 419-901-3176
Fax Number :
Provider Business Practice Location Address
First Line : 7540 NEW WEST RD
Second Line :
City : TOLEDO
State : OH
Zip : 43617-4200
Country : US
Telephone Number : 419-901-3176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2018
Last Update Date : 06/13/2018

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