Provider Demographics
NPI:1972616399
Name:ROMAN, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:ROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:M
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:499 E HAMPDEN AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2780
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:303-790-2567
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:STE 420
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2780
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:303-790-2567
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36250207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01362508Medicaid
COC35118Medicare PIN
CO100014496Medicare PIN