Provider Demographics
NPI:1144262072
Name:JHA, ROMEN K (MD)
Entity type:Individual
Prefix:
First Name:ROMEN
Middle Name:K
Last Name:JHA
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:PO BOX 27776
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7776
Mailing Address - Country:US
Mailing Address - Phone:480-755-2210
Mailing Address - Fax:480-755-2364
Practice Address - Street 1:2501 E SOUTHERN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7669
Practice Address - Country:US
Practice Address - Phone:480-755-2210
Practice Address - Fax:480-755-2364
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ913550Medicaid
AZZ113945Medicare PIN