Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 73867 | WI |
N | 207WX0107X | Retina Specialist | D79459 | MD |
N | 207WX0107X | Retina Specialist | R6363 | TX |
NPI | 1013204163 |
---|---|
Provider Name | Dr. Roomasa Channa |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705-3644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 08/02/2021 |