Provider Demographics
NPI:1467535146
Name:ROMAN, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
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 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:610-770-1606
Mailing Address - Fax:610-740-0560
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 3600
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:610-740-0560
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058040L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0181589901OtherAMERICHOICE
PA0018158990001Medicaid
PA273419OtherBLUE SHIELD PA
PA3503472OtherAETNA
PA0548839000OtherKEYSTONE HEALTHPLAN EAST
PA0548839000OtherKEYSTONE HEALTHPLAN EAST
PAG78441Medicare UPIN
PA300107001Medicare ID - Type UnspecifiedRR MEDICARE
PA015740Medicare PIN