Provider Demographics
NPI:1144951245
Name:ROMAN, MADISON E (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:E
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15838 N 62ND PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1991
Mailing Address - Country:US
Mailing Address - Phone:602-881-9209
Mailing Address - Fax:
Practice Address - Street 1:1003 BELLEFONTAINE AVE STE 125
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1867
Practice Address - Country:US
Practice Address - Phone:419-998-8207
Practice Address - Fax:419-998-8216
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0009928Medicaid