Provider Demographics
NPI:1225049547
Name:ROMAN, AMAURY ARNALDO (MD,)
Entity Type:Individual
Prefix:DR
First Name:AMAURY
Middle Name:ARNALDO
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:AMAURY
Other - Middle Name:A
Other - Last Name:ROMAN MIRANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:PO BOX 1802
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1802
Mailing Address - Country:US
Mailing Address - Phone:787-739-3376
Mailing Address - Fax:787-714-1134
Practice Address - Street 1:4 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3318
Practice Address - Country:US
Practice Address - Phone:787-739-3376
Practice Address - Fax:787-714-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5872208D00000X
GA057659208D00000X
MI4301087098208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-00146Medicare UPIN
PR27251Medicare ID - Type Unspecified