Provider Demographics
NPI:1396752986
Name:SINGH, ROSHAN LALTA HIRA (MD)
Entity type:Individual
Prefix:
First Name:ROSHAN
Middle Name:LALTA HIRA
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSHAN
Other - Middle Name:L
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2215 NEBRASKA AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4864
Mailing Address - Country:US
Mailing Address - Phone:772-464-8722
Mailing Address - Fax:772-464-9978
Practice Address - Street 1:2215 NEBRASKA AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4864
Practice Address - Country:US
Practice Address - Phone:772-464-8722
Practice Address - Fax:772-464-9978
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery