Provider Demographics
NPI:1104838515
Name:BASHIR, ROSHAN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHAN
Middle Name:MARTIN
Last Name:BASHIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSHAN
Other - Middle Name:MARTIN
Other - Last Name:BASHIR-ELAHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:106 IRVING STREET NW
Mailing Address - Street 2:STE 205
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-829-5192
Mailing Address - Fax:202-823-4821
Practice Address - Street 1:106 IRVING STREET NW
Practice Address - Street 2:STE 205
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-829-5192
Practice Address - Fax:202-823-4821
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050897207RG0100X
DCMD20565207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC110145182OtherMEDICARE RAILROAD
MD518000700Medicaid
DC029507800Medicaid
DC029507800Medicaid
DC776495M02Medicare PIN