Provider Demographics
NPI:1982647723
Name:ROUMANI, FAYEZ (MD)
Entity Type:Individual
Prefix:
First Name:FAYEZ
Middle Name:
Last Name:ROUMANI
Suffix:
Gender:M
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:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-0522
Mailing Address - Country:US
Mailing Address - Phone:814-362-4075
Mailing Address - Fax:814-362-4075
Practice Address - Street 1:199 PLEASANT ST
Practice Address - Street 2:SUITE 24
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1098
Practice Address - Country:US
Practice Address - Phone:814-362-4075
Practice Address - Fax:814-362-4075
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037066-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006136650001Medicaid
PA49467Medicare PIN
C28409Medicare UPIN
PA0006136650001Medicaid