Provider Demographics
NPI:1073693594
Name:PURCELL, ROLAND ROYSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:ROYSTON
Last Name:PURCELL
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 1:661 EAST 84TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3427
Mailing Address - Country:US
Mailing Address - Phone:718-778-3311
Mailing Address - Fax:718-953-1178
Practice Address - Street 1:83 EAST 38TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2006
Practice Address - Country:US
Practice Address - Phone:718-778-3311
Practice Address - Fax:718-953-1178
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1572042086S0129X, 207P00000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00968685Medicaid
NYA64280Medicare UPIN
NY00968685Medicaid