MEDICARE: KATRINA COLE ROMBLAD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	104051	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105174	OTHER	NC	UNITED HEALTHCARE
2	D6461	OTHER	NC	MEDCOST

General Provider Information

NPI Number	:	1295711398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA COLE ROMBLAD PA-C

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7276
Country	:	US
Telephone Number	:	336-788-4664
Fax Number	:	336-788-0573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	09/20/2023

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