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General NPI Number Information
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NPI Number | 1134333966
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Entity Type | Organization
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Legal Business Name | MANUEL ROMAN MD PA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 12625 SAFETY TURN
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City | BOWIE
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State | MD
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Zip | 20715
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Country | US
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Telephone | 301-809-3334
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Fax | 301-262-9610
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Provider Business Mailing Address
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Address Line | 12625 SAFETY TURN
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City | BOWIE
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State | MD
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Zip | 20715
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Country | US
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Telephone | 301-809-3334
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Fax | 301-262-9610
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Authorized Official
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Title or Position | OWNER
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Name | MANUEL W ROMAN
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Credential | MD
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Telephone | 301-809-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D09630
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License Number State | MD
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