Provider Demographics
NPI:1861401887
Name:ROMAN, ANGEL M (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CARR.129 KM 8.3 BO. CAMPO ALEGRE
Mailing Address - Street 2:BOX 2008
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-878-3501
Mailing Address - Fax:787-544-6969
Practice Address - Street 1:PO BOX 141126
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614-1126
Practice Address - Country:US
Practice Address - Phone:787-878-3501
Practice Address - Fax:787-880-7232
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4957207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C78222Medicare UPIN