Healthcare Provider Details

I. General information

NPI: 1083600555
Provider Name (Legal Business Name): ANGELIE D ROMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY SUITE 700
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY SUITE 700
EAST SYRACUSE NY
13057-9248
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7504
  • Fax: 315-479-8639
Mailing address:
  • Phone: 315-472-7504
  • Fax: 315-479-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number215535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: