| Doctor Name: | DOMENICK J ROMA |
| NPI Number: | 1023278967 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 148977 |
| Business Practice Address: | 4700 Waters Ave Suite 507 Savannah, GA - 314046220 |
| Business Phone Number: | 9123504750 |
| Business Fax Number: | 9123504751 |
| Mailing Address: | 4700 Waters Ave, Suite 507 SAVANNAH |
| State: | GA |
| Postal Code: | 314046220 |
| Phone Number: | 9123504750 |
| Fax Number: | 9123504751 |
| NPI Enumeration Date: | 06/13/2008 |
| NPI Last Update Date: | 05/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 148977 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |