Provider Demographics
NPI:1720769532
Name:GOLDSON, ROHAN
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:GOLDSON
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 1:86 STILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1825
Mailing Address - Country:US
Mailing Address - Phone:516-749-2669
Mailing Address - Fax:
Practice Address - Street 1:86 STILL HILL RD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1825
Practice Address - Country:US
Practice Address - Phone:516-749-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
CT3778172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriver