Healthcare Provider Details

I. General information

NPI: 1407853153
Provider Name (Legal Business Name): ANTHONY ROMANIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 PLAZA CT
GROTON CT
06340-4223
US

IV. Provider business mailing address

82 PLAZA CT
GROTON CT
06340-4223
US

V. Phone/Fax

Practice location:
  • Phone: 860-629-0900
  • Fax: 860-629-0912
Mailing address:
  • Phone: 860-629-0900
  • Fax: 860-629-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number038208
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: