Provider Demographics
NPI:1881002319
Name:ROMAN-ASHBY, GLORIAN MARI (MD)
Entity Type:Individual
Prefix:
First Name:GLORIAN
Middle Name:MARI
Last Name:ROMAN-ASHBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GERIATRIC CLINIC-STICHT CENTER MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-8250
Mailing Address - Fax:336-713-8252
Practice Address - Street 1:GERIATRIC CLINIC-STICHT CENTER MEDICAL CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-8250
Practice Address - Fax:336-713-8252
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC226765207RG0300X
KYR3606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine