MEDICARE: ANTONIO ROMAN, MD, PA

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	2084P0800X	Psychiatry Physician	J7286	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8C6525	OTHER		MEDICARE
2	00437X	OTHER		MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1124009543	OTHER	TX	ANTONIO ROMAN INDIVIDUAL NPI

General Provider Information

NPI Number	:	1750562237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONIO ROMAN, MD, PA

Provider Business Mailing Address
First Line	:	110 W SANDY LAKE RD STE 102
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-2529
Country	:	US
Telephone Number	:	972-315-5249
Fax Number	:

Provider Business Practice Location Address
First Line	:	6116 N CENTRAL EXPY
Second Line	:	SUITE 915
City	:	DALLAS
State	:	TX
Zip	:	75206-5162
Country	:	US
Telephone Number	:	214-969-2953
Fax Number	:	214-363-2899

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTONIO ROMAN
Credential	:	MD
Telephone Number	:	214-969-2953

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	08/28/2008

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Directions to “ANTONIO ROMAN, MD, PA ” Practice Location

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