Provider Demographics
NPI:1477631109
Name:ISLAM, PARVEZ S (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVEZ
Middle Name:S
Last Name:ISLAM
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 1:508 GIBSON DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5794
Mailing Address - Country:US
Mailing Address - Phone:916-783-1080
Mailing Address - Fax:916-783-1090
Practice Address - Street 1:508 GIBSON DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5794
Practice Address - Country:US
Practice Address - Phone:916-783-1080
Practice Address - Fax:916-783-1090
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51863207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C518630Medicaid
00C518631Medicare PIN
H00905Medicare UPIN