Healthcare Provider Details

I. General information

NPI: 1134740673
Provider Name (Legal Business Name): JOHANNA C ROMO RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY
BANGOR ME
04401-3979
US

IV. Provider business mailing address

360 BROADWAY
BANGOR ME
04401-3979
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-1187
  • Fax:
Mailing address:
  • Phone: 207-907-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD29214
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: