Healthcare Provider Details

I. General information

NPI: 1932360849
Provider Name (Legal Business Name): COLETTE DENISE ROMEO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLETTE DENISE TERRY M.D.

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SW 30TH AVE SUITE 101, DERMPATH DIAGNOSTICS
POMPANO BEACH FL
33069-4887
US

IV. Provider business mailing address

14275 MIDWAY RD STE 400
ADDISON TX
75001-3676
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-6770
  • Fax: 954-633-3217
Mailing address:
  • Phone: 972-934-4392
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD436150
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberBP10034758
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME108023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: