MEDICARE: DR. CARMEN ROSA FORTUNO ROMAN M.D.

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	208000000X	Pediatrics Physician	18970	PR
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	18970	PR
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	2016-01382	NC
4	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME133918	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184817256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMEN ROSA FORTUNO ROMAN M.D.

Provider Business Mailing Address
First Line	:	6000 TURKEY LAKE RD STE 205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4206
Country	:	US
Telephone Number	:	407-649-1848
Fax Number	:	407-649-1979

Provider Business Practice Location Address
First Line	:	6000 TURKEY LAKE RD STE 205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4206
Country	:	US
Telephone Number	:	407-649-1848
Fax Number	:	407-649-1979

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	12/06/2021

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