Provider Demographics
NPI:1639105315
Name:ROSHAN, SOHAILA Y (MD)
Entity Type:Individual
Prefix:
First Name:SOHAILA
Middle Name:Y
Last Name:ROSHAN
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 1:709 HOLLYBROOK DR STE 4500
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2412
Mailing Address - Country:US
Mailing Address - Phone:903-757-6042
Mailing Address - Fax:903-232-8260
Practice Address - Street 1:709 HOLLYBROOK DR STE 4500
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2412
Practice Address - Country:US
Practice Address - Phone:903-757-6042
Practice Address - Fax:903-232-8260
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8748207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00338108OtherMEDICARE RR
TX174071406Medicaid
TX174071405Medicaid
TX295643YKS4Medicare PIN
TX174071401Medicaid
TX8D6942Medicare PIN
TX174071405Medicaid