Provider Demographics
NPI:1518036748
Name:ROMAN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 GRAND PRIX LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2704
Mailing Address - Country:US
Mailing Address - Phone:201-421-5774
Mailing Address - Fax:
Practice Address - Street 1:1021 N STATE ROAD 7 STE 120
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5117
Practice Address - Country:US
Practice Address - Phone:201-428-5774
Practice Address - Fax:561-792-2918
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E53540Medicare UPIN
NJ579359Medicare ID - Type Unspecified