Provider Demographics
NPI:1982439162
Name:ROLAND, INDIA N
Entity type:Individual
Prefix:
First Name:INDIA
Middle Name:N
Last Name:ROLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 W SENECA TPKE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9646
Mailing Address - Country:US
Mailing Address - Phone:315-269-5142
Mailing Address - Fax:
Practice Address - Street 1:3239 W SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9646
Practice Address - Country:US
Practice Address - Phone:315-269-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20-0702Y19251E00000X
246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
No251E00000XAgenciesHome Health