Provider Demographics
NPI:1861996290
Name:ROALKVAM, SOPHIA MADAHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:MADAHAR
Last Name:ROALKVAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:MADAHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8207 E MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1734
Mailing Address - Country:US
Mailing Address - Phone:909-472-6885
Mailing Address - Fax:
Practice Address - Street 1:6242 E ARBOR AVE STE 111-113
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1309
Practice Address - Country:US
Practice Address - Phone:480-536-6863
Practice Address - Fax:480-718-1301
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ63941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program