Provider Demographics
NPI:1750562237
Name:ANTONIO ROMAN, MD, PA
Entity type:Organization
Organization Name:ANTONIO ROMAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-969-2953
Mailing Address - Street 1:110 W SANDY LAKE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2529
Mailing Address - Country:US
Mailing Address - Phone:972-315-5249
Mailing Address - Fax:
Practice Address - Street 1:6116 N CENTRAL EXPY
Practice Address - Street 2:SUITE 915
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5162
Practice Address - Country:US
Practice Address - Phone:214-969-2953
Practice Address - Fax:214-363-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ72862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C6525OtherMEDICARE
00437XOtherMEDICARE GROUP
TX168921801OtherMEDICAID GROUP
TX1124009543OtherANTONIO ROMAN INDIVIDUAL NPI
TX1124009543OtherANTONIO ROMAN INDIVIDUAL NPI