Provider Demographics
NPI:1831199587
Name:ROMAN, DAWN CARROLL (PA-C)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:CARROLL
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:CARROLL
Other - Last Name:GERCHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:630-495-1770
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 280
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-744-8554
Practice Address - Fax:815-744-3969
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000242A363AS0400X
IL085000381363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBC/BS
IL970000814Medicare PIN
IL970022849Medicare PIN
ILL79839Medicare PIN
ILR78560Medicare UPIN
IL01618941OtherBC/BS
IN970022852Medicare PIN
IN408430JMedicare PIN