Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101244888 | VA |
NPI | 1003832502 |
---|---|
Provider Name | Dr. Roshan Kalim |
First Address | Manassas, VA 20109-7282 |
Second Address | Manassas, VA 20109-7282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 28/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I24290 | (02) | PA |
MD426752 | MD LICENSE (01) | PA |