Healthcare Provider Details

I. General information

NPI: 1013197201
Provider Name (Legal Business Name): LAUREN ROMEO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 W HIBISCUS BLVD STE B
MELBOURNE FL
32901-2639
US

IV. Provider business mailing address

1698 W HIBISCUS BLVD STE B
MELBOURNE FL
32901-2639
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-2012
  • Fax:
Mailing address:
  • Phone: 321-676-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME92448
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberME92448
License Number StateFL

VIII. Authorized Official

Name: DR. LAUREN ROMEO
Title or Position: OWNER
Credential: M.D.
Phone: 321-676-2012