MEDICARE: BENNETT 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	57136	TN

General Provider Information

NPI Number	:	1164877478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNETT ROMAN MD

Provider Business Mailing Address
First Line	:	719 THOMPSON LN STE 30330
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-4701
Country	:	US
Telephone Number	:	615-936-1830
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-7237
Country	:	US
Telephone Number	:	615-322-3000
Fax Number	:

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	05/19/2020

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