Healthcare Provider Details

I. General information

NPI: 1093486359
Provider Name (Legal Business Name): CARLOS A ROMERO-ESCOBAR JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 09/25/2021
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 RIDGELYS CHOICE DR
NOTTINGHAM MD
21236-2953
US

IV. Provider business mailing address

9417 TWILIGHT DR UNIT A
BALTIMORE MD
21236-1625
US

V. Phone/Fax

Practice location:
  • Phone: 855-910-3278
  • Fax:
Mailing address:
  • Phone: 443-703-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR204504
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: