Provider Demographics
NPI:1619998861
Name:MAHTANI, ROSHAN V (MD)
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:V
Last Name:MAHTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSHAN
Other - Middle Name:B
Other - Last Name:DARYANANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:38135 MARKET SQUARE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542
Mailing Address - Country:US
Mailing Address - Phone:813-528-4975
Mailing Address - Fax:
Practice Address - Street 1:6830 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2503
Practice Address - Country:US
Practice Address - Phone:813-783-3118
Practice Address - Fax:813-355-5036
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272021300Medicaid
FLP00225143OtherRR MEDICARE
FL01566ZMedicare PIN
FL272021300Medicaid