Provider Demographics
NPI:1558649061
Name:ROMAN, MATTHEW ANTONI (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANTONI
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MATEUSZ
Other - Middle Name:ANTONI
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1224 N KING ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3232
Mailing Address - Country:US
Mailing Address - Phone:855-420-3627
Mailing Address - Fax:855-696-3299
Practice Address - Street 1:131 N 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1995
Practice Address - Country:US
Practice Address - Phone:844-472-9333
Practice Address - Fax:855-696-3299
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452451207R00000X
DEC1-0011364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0011364OtherDE LICENCE
PAMD452451OtherMEDICAL LICENSE