Provider Demographics
NPI:1083833131
Name:CULJAT, ROMAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:MARK
Last Name:CULJAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SAINT PAUL ST RM 409
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-332-9732
Mailing Address - Fax:410-649-3451
Practice Address - Street 1:301 SAINT PAUL ST RM 409
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-9732
Practice Address - Fax:410-649-3451
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0092057207RS0012X, 207RP1001X
CAA79991207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083833131OtherCCS PANELED
MD206984900Medicaid
CA1083833131Medicaid
CAGW992ZMedicare PIN