Healthcare Provider Details

I. General information

NPI: 1407878515
Provider Name (Legal Business Name): ROSHAN KOOZEKANANI M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2593
US

IV. Provider business mailing address

3811 OHARA ST
PITTSBURGH PA
15213-2593
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-6792
  • Fax: 412-586-9532
Mailing address:
  • Phone: 412-624-1000
  • Fax: 412-586-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD067464L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: