Provider Demographics
NPI:1093877144
Name:MOSAI, ROMAN (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:MOSAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROMANCHAL
Other - Middle Name:
Other - Last Name:MOSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9112 DOLLANGER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4064
Mailing Address - Country:US
Mailing Address - Phone:407-822-4739
Mailing Address - Fax:407-822-4789
Practice Address - Street 1:5084 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7666
Practice Address - Country:US
Practice Address - Phone:407-822-4739
Practice Address - Fax:407-822-4789
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40999207P00000X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0474711-00Medicaid
FL05643ZMedicare ID - Type Unspecified
FL0474711-00Medicaid