Provider Demographics
NPI:1598933525
Name:ROMAN, KATHARINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:H
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHARINE
Other - Middle Name:H
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5985 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3039
Mailing Address - Country:US
Mailing Address - Phone:208-853-0071
Mailing Address - Fax:208-853-9422
Practice Address - Street 1:5985 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-3039
Practice Address - Country:US
Practice Address - Phone:208-853-0071
Practice Address - Fax:208-853-9422
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-108982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry