Provider Demographics
NPI:1043280407
Name:ROSHAN, BIJAN (MD)
Entity Type:Individual
Prefix:
First Name:BIJAN
Middle Name:
Last Name:ROSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE #565
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-777-3333
Mailing Address - Fax:303-733-4441
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE # 565
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-777-3333
Practice Address - Fax:303-733-4441
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8789207R00000X, 207RN0300X
MA155137207R00000X, 207RN0300X
WI38341207R00000X
CO51352207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA108620OtherINDIVIDUAL PTAN
CO20028270Medicaid
MT9988792Medicaid
MA3205398Medicaid
CO20028270Medicaid
COCOA108620OtherINDIVIDUAL PTAN
MTHZA430Medicare UPIN
MT9988792Medicaid