Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101239657 | VA |
N | 111NI0900X | Internist | 0101239657 | VA |
N | 207RG0300X | Geriatric Medicine | 0101239657 | VA |
NPI | 1023071057 |
---|---|
Provider Name | Irene Paula San Roman |
First Address | Suffolk, VA 23435-4206 |
Second Address | Hampton, VA 23667-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |