Provider Demographics
NPI:1477651966
Name:SKORACKI, ROMAN J (MD)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:J
Last Name:SKORACKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-0223
Mailing Address - Fax:614-293-7232
Practice Address - Street 1:1145 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3117
Practice Address - Country:US
Practice Address - Phone:614-293-0223
Practice Address - Fax:614-293-7232
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35123775208200000X
TXL26602086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112282Medicaid
OH0112282Medicaid
OHH397070Medicare PIN
H50584Medicare UPIN