Basic Information
| Provider Information | |||||||||
| NPI: | 1922072495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | DARBY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 HITCHCOCK FARM RD | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784755489 | ||||||||
| FaxNumber: | 9782759552 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 RESEARCH PL | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782759650 | ||||||||
| FaxNumber: | 9782759552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2006 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 59057 | MA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3067149 | 05 | MA | MEDICAID |