Roman, Mark David
Roman, Mark David is an sole proprietor health care provider with primary practice located at 225 Mary Wallace Way , Dallas GA 30157-5054. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Roman, Mark David can be contacted via phone (770) 608-3302.Contact Information
Primary practice address
225 Mary Wallace Way
Dallas GA 30157-5054
Phone: (770) 608-3302
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA9101641 | Florida |
Profile Details
| NPI number | 1588692602 |
|---|---|
| LBN Legal business name | Roman, Mark David |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 29th, 2006 |
| Last updated | Aug 13th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588692602 | NPPES |
| Florida | MEDICAID | 291095100 |
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