Provider Demographics
NPI:1447358213
Name:ROMAN, REGINA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:ANN
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:154A WACCAMAW MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8965
Mailing Address - Country:US
Mailing Address - Phone:843-347-5752
Mailing Address - Fax:843-347-5756
Practice Address - Street 1:154A WACCAMAW MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8965
Practice Address - Country:US
Practice Address - Phone:843-347-5752
Practice Address - Fax:843-347-5756
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC0390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF80975Medicare UPIN