Provider Demographics
NPI:1407155690
Name:ROMAN, CHRISTOPHER THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:THOMAS
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12302 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5807
Mailing Address - Country:US
Mailing Address - Phone:317-564-4836
Mailing Address - Fax:317-587-2342
Practice Address - Street 1:11455 N. MERIDIAN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1680
Practice Address - Country:US
Practice Address - Phone:317-582-8180
Practice Address - Fax:317-582-8185
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001249A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1407155690Medicare UPIN
IN095700 004Medicare PIN