Provider Demographics
NPI:1053389437
Name:HOOSHMAND, ROSHANN L (MD)
Entity type:Individual
Prefix:
First Name:ROSHANN
Middle Name:L
Last Name:HOOSHMAND
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0549
Mailing Address - Country:US
Mailing Address - Phone:508-477-5306
Mailing Address - Fax:508-477-0297
Practice Address - Street 1:55 ROUTE 130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1402
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:508-477-0297
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB1052201OtherCIGNA
MA204157OtherHARVARD PILGRIM HEALTH
MAJ22216OtherBLUE CROSS BLUE SHIELD
MA000000029532OtherBOSTON MEDIAL CHILDRENS H
MA043541176OtherCOMMERCIAL INSURANCES
MA1201881OtherUNITED HEALTH CARE
MA203806OtherTUFTS HEALTH PLAN
MA585270OtherHEALTH SOURCE
MA0109410Medicaid
MA405489OtherUNIFORMED FAMILY HEALTH P
MA405489OtherUNIFORMED FAMILY HEALTH P
MA585270OtherHEALTH SOURCE