Healthcare Provider Details

I. General information

NPI: 1083833131
Provider Name (Legal Business Name): ROMAN MARK CULJAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST RM 409
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST RM 409
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9732
  • Fax: 410-649-3451
Mailing address:
  • Phone: 410-332-9732
  • Fax: 410-649-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0092057
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberD0092057
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: