Provider Demographics
NPI:1861667784
Name:PETER D. ROMAN, MD, PC
Entity Type:Organization
Organization Name:PETER D. ROMAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-275-9650
Mailing Address - Street 1:10 RESEARCH PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2439
Mailing Address - Country:US
Mailing Address - Phone:978-275-9650
Mailing Address - Fax:
Practice Address - Street 1:10 RESEARCH PL
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2439
Practice Address - Country:US
Practice Address - Phone:978-275-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59057207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16955OtherBLUE SHIELD