Provider Demographics
NPI:1255719811
Name:ROMAN, PETER ANDREW (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:ROMAN
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 1:89 FORBES BLVD STE 1000A
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1281
Mailing Address - Country:US
Mailing Address - Phone:508-339-9944
Mailing Address - Fax:508-452-3898
Practice Address - Street 1:89 FORBES BLVD STE 1000A
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1281
Practice Address - Country:US
Practice Address - Phone:508-339-9944
Practice Address - Fax:508-452-3898
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274298208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty