Provider Demographics
NPI:1508067745
Name:POLITI, ROMAN GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:GABRIEL
Last Name:POLITI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 DATES DR
Mailing Address - Street 2:DEPARTMENT OF INTERVENTIONAL RADIOLOGY
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1342
Mailing Address - Country:US
Mailing Address - Phone:607-277-3790
Mailing Address - Fax:
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:DEPARTMENT OF INTERVENTIONAL RADIOLOGY
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-277-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2015-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2505902085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology