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1598709206

NPI Code Detail

MEDICARE: CHERYL VALERIE ROZANOV MD

MEDICARE: CHERYL VALERIE ROZANOV MD

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
1	2084P0804X	Child & Adolescent Psychiatry Physician	M0992	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	2006-01890	NC
3	2084P0800X	Psychiatry Physician	2006-01890	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	146CV	OTHER	NC	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8S1680	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1598709206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL VALERIE ROZANOV MD

Provider Business Mailing Address
First Line	:	284 EXECUTIVE PARK DR
Second Line	:	SUITE 100
City	:	CONCORD
State	:	NC
Zip	:	28025-1831
Country	:	US
Telephone Number	:	704-939-1100
Fax Number	:	704-939-1173

Provider Business Practice Location Address
First Line	:	1104A S MAIN ST
Second Line	:	DAYMARK RECOVERY SERVICES INC
City	:	LEXINGTON
State	:	NC
Zip	:	27292-3134
Country	:	US
Telephone Number	:	336-242-2450
Fax Number	:	336-249-9920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/23/2022

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Directions to “ CHERYL VALERIE ROZANOV MD” Practice Location

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