Provider Demographics
NPI:1184744336
Name:ROY, DEBORSHI (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORSHI
Middle Name:
Last Name:ROY
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:PO BOX 77365
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0112
Mailing Address - Country:US
Mailing Address - Phone:909-466-8400
Mailing Address - Fax:909-880-1102
Practice Address - Street 1:8241 ROCHESTER AVE 130
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0713
Practice Address - Country:US
Practice Address - Phone:909-466-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54320207YX0905X
NY2286241207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY228624OtherLICENSE
NY228624OtherLICENSE
7M3871Medicare ID - Type Unspecified