Provider Demographics
NPI:1154568350
Name:PATTATHU, ROSHNY ANTONY (MD)
Entity type:Individual
Prefix:
First Name:ROSHNY
Middle Name:ANTONY
Last Name:PATTATHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MOMENTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4239
Mailing Address - Country:US
Mailing Address - Phone:949-235-7243
Mailing Address - Fax:954-516-0921
Practice Address - Street 1:17 MOMENTO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603
Practice Address - Country:US
Practice Address - Phone:949-235-7243
Practice Address - Fax:954-516-0921
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106185207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFP1256583OtherDEA
CAFP1256583OtherDEA
CACH837WMedicare PIN
CACH837ZMedicare PIN
CACH837XMedicare PIN