Provider Demographics
NPI:1821603960
Name:COORAY, ROSHAN S
Entity Type:Individual
Prefix:
First Name:ROSHAN
Middle Name:S
Last Name:COORAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 CORBEL WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2757
Mailing Address - Country:US
Mailing Address - Phone:202-422-2135
Mailing Address - Fax:
Practice Address - Street 1:6612 CORBEL WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2757
Practice Address - Country:US
Practice Address - Phone:202-422-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)