Provider Demographics
NPI:1194862110
Name:ROMAN, CARMEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:M
Last Name:ROMAN
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:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-0440
Mailing Address - Country:US
Mailing Address - Phone:787-817-3611
Mailing Address - Fax:787-817-3611
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URB. VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-817-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics