| Roman Medical Llc | |
|
460 Raccoon St Lake Mary FL 32746-3802 | |
| (407) 739-6208 | |
| (407) 878-6548 |
| Full Name | Roman Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 460 Raccoon St, Lake Mary, Florida |
| Authorized Official Name and Position | Clara I Roman (REGISTERED AGENT) |
| Authorized Official Contact | 4077396208 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roman Medical Llc 460 Raccoon St Lake Mary FL 32746-3802 Ph: (407) 739-6208 | Roman Medical Llc 460 Raccoon St Lake Mary FL 32746-3802 Ph: (407) 739-6208 |
| NPI Number | 1477870160 |
|---|---|
| Provider Enumeration Date | 04/21/2010 |
| Last Update Date | 04/29/2013 |
| Medicare PECOS PAC ID | 6406986165 |
|---|---|
| Medicare Enrollment ID | O20100608000092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477870160 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME103345 (Florida) | Primary |
| Provider Name | Clara I Roman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225274343 PECOS PAC ID: 0941330609 Enrollment ID: I20100608000121 |
| Provider Name | Tanya Magdor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164446571 PECOS PAC ID: 6204905284 Enrollment ID: I20110112000018 |
| Provider Name | Shelley R Jennings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083245906 PECOS PAC ID: 3476965146 Enrollment ID: I20201222001775 |
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