MEDICARE: DR. GERARDO RIVERA ROMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101259841	VA
2	207R00000X	Internal Medicine Physician	020042	PR

General Provider Information

NPI Number	:	1033461934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO RIVERA ROMAN MD

Provider Business Mailing Address
First Line	:	4000 COLISEUM DR STE 445
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-5981
Country	:	US
Telephone Number	:	757-763-8618
Fax Number	:

Provider Business Practice Location Address
First Line	:	#645 CALLE # 18
Second Line	:	COMUNIDAD CABAN
City	:	AGUADILLA
State	:	PR
Zip	:	00603
Country	:	US
Telephone Number	:	757-763-8618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	03/18/2026

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