Provider Demographics
NPI:1801977830
Name:ROMAN, DOLORES ANN (DO)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:ANN
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DOLORES
Other - Middle Name:ROMAN
Other - Last Name:HOEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:35 W HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3610
Mailing Address - Country:US
Mailing Address - Phone:215-919-3070
Mailing Address - Fax:
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB077805207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MBN077805OtherSTATE LICENSE
NJDO8586800OtherSTNA