Provider Demographics
NPI:1285818385
Name:ROMAN UROLOGY GROUP PSC
Entity Type:Organization
Organization Name:ROMAN UROLOGY GROUP PSC
Other - Org Name:ROMAN UROLOGY GROUP PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN-TORREGUITART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-834-8160
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1230
Mailing Address - Country:US
Mailing Address - Phone:787-834-8160
Mailing Address - Fax:787-265-5777
Practice Address - Street 1:746 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1538
Practice Address - Country:US
Practice Address - Phone:787-834-8160
Practice Address - Fax:787-265-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14210208800000X
PR18018208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCU340AOtherMEDICARE PROVIDER NUMBER