Healthcare Provider Details

I. General information

NPI: 1851348932
Provider Name (Legal Business Name): CHARLES A. ROMICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 GLENDALE AVE #131
SPARKS NV
89431-5511
US

IV. Provider business mailing address

PO BOX 21530
CARSON CITY NV
89721-1530
US

V. Phone/Fax

Practice location:
  • Phone: 775-331-3361
  • Fax: 775-331-4719
Mailing address:
  • Phone: 775-884-2455
  • Fax: 775-884-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5783
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: