Provider Demographics
NPI:1639282429
Name:ROMAN, ABDIEL ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:ABDIEL
Middle Name:ALEXIS
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 1:223 CALLE SEGUNDO FELICIANO
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4549
Mailing Address - Country:US
Mailing Address - Phone:787-877-8369
Mailing Address - Fax:
Practice Address - Street 1:223 CALLE SEGUNDO FELICIANO
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4549
Practice Address - Country:US
Practice Address - Phone:787-877-8369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16533208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice