Provider Demographics
NPI:1053677351
Name:FEDERICO ROMAN NG, MDPA
Entity Type:Organization
Organization Name:FEDERICO ROMAN NG, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:ROMAN
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-2828
Mailing Address - Street 1:7922 EWING HALSELL DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3786
Mailing Address - Country:US
Mailing Address - Phone:210-614-2828
Mailing Address - Fax:210-614-2558
Practice Address - Street 1:7922 EWING HALSELL DR
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3786
Practice Address - Country:US
Practice Address - Phone:210-614-2828
Practice Address - Fax:210-614-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528061488OtherNPI-INDIVIDUAL