Healthcare Provider Details

I. General information

NPI: 1700148277
Provider Name (Legal Business Name): JOHN W ROMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 KEMPSVILLE RD STE 309
NORFOLK VA
23502-3800
US

IV. Provider business mailing address

PO BOX 947977
ATLANTA GA
30394-7977
US

V. Phone/Fax

Practice location:
  • Phone: 757-347-2712
  • Fax: 757-502-8933
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20101
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101254438
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: