Healthcare Provider Details

I. General information

NPI: 1275855678
Provider Name (Legal Business Name): MARGARET MADDOX ROMANO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET MICHELLE MADDOX

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E 2ND ST
DULUTH MN
55805-1906
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax: 218-249-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10696
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: