Provider Demographics
NPI:1831308618
Name:ROMAN, ELLIS AUDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELLIS
Middle Name:AUDA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8901
Mailing Address - Street 2:POSTALMAIL BOX 028 POSTALOFFICE BOX 8901
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9141
Mailing Address - Country:US
Mailing Address - Phone:787-632-4707
Mailing Address - Fax:787-882-1125
Practice Address - Street 1:METRO OFICCE PARK LOTE 18 CALLE 1 SUITE 400
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-882-5450
Practice Address - Fax:787-882-1125
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13797208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice