Provider Demographics
NPI:1780679969
Name:ROLAND, PHILLIP Y (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:Y
Last Name:ROLAND
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-7945
Mailing Address - Fax:860-714-8880
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 2110
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-714-7945
Practice Address - Fax:860-714-8880
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080439207VX0201X
CT046991207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2541920OtherAETNA PROVIDER NUMBER
FL36-00184OtherUTD. HLTHCR. PROVIDER #
FL851882OtherFIRST HEALTH PROVIDER #
FL920005669OtherRAILROAD MEDICARE
FL259334300Medicaid
FL3503291-002OtherCIGNA PROVIDER NUMBER
FL35479OtherBCBS OF FL. PROVIDER #
FL5250568OtherAETNA OTHER PROV. #
FL3503291-002OtherCIGNA PROVIDER NUMBER
FLF61560Medicare UPIN