Provider Demographics
NPI:1326234170
Name:DHAWALE, ROSHAN (MD)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:
Last Name:DHAWALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 HANNAFORD LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6500
Mailing Address - Country:US
Mailing Address - Phone:413-204-2091
Mailing Address - Fax:
Practice Address - Street 1:710 LAWRENCE EXPY FL 1
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440032207RR0500X
GA84839207RR0500X
CAC183356207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027726514Medicaid
PA184947Medicare PIN