Individual
MIGUEL ANGEL ROMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
35 UNION ST, APT. 521, NEW LONDON, CT 06320-6136
(787) 247-0572
Mailing address
159 TROUT AVE, GROTON, CT 06349
(787) 247-0572
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7987
SUBMARINE INDEPENDENT DUTY CORPSMAN
—
Enumeration date
04/19/2013
Last updated
04/19/2013
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