Provider Demographics
NPI:1386090686
Name:ACHARYA, ROSHAN (MD)
Entity type:Individual
Prefix:
First Name:ROSHAN
Middle Name:
Last Name:ACHARYA
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 1:1638 OWEN DR
Mailing Address - Street 2:C/O CYNTHIA EDELMAN
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:917-714-6790
Mailing Address - Fax:910-615-5681
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:C/O CYNTHIA EDELMAN
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:917-714-6790
Practice Address - Fax:910-615-5681
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2019-01776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program