Provider Demographics
NPI:1154313849
Name:ROMAN CARLO, ROSA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ISABEL
Last Name:ROMAN CARLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 NORTH BASORA STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-0055
Mailing Address - Country:US
Mailing Address - Phone:787-833-5090
Mailing Address - Fax:787-833-5090
Practice Address - Street 1:55 NORTH BASORA STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0055
Practice Address - Country:US
Practice Address - Phone:787-833-5090
Practice Address - Fax:787-833-5090
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9009207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82459Medicare ID - Type Unspecified
PRE83598Medicare UPIN