Provider Demographics
NPI:1770774804
Name:ROMAN-GERARDINO, MELINA A (MD)
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:A
Last Name:ROMAN-GERARDINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 PRYTANIA ST STE 35
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3678
Mailing Address - Country:US
Mailing Address - Phone:504-897-8412
Mailing Address - Fax:504-249-5311
Practice Address - Street 1:3525 PRYTANIA ST STE 402
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3585
Practice Address - Country:US
Practice Address - Phone:504-648-2520
Practice Address - Fax:504-897-2939
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203002207R00000X, 208M00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000990Medicaid
MS01122754Medicaid
MS01122754Medicaid