Healthcare Provider Details

I. General information

NPI: 1669863379
Provider Name (Legal Business Name): ROME MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 TURIN RD BUILDING 4, SUITE 2
ROME NY
13440-1900
US

IV. Provider business mailing address

7900 TURIN RD BUILDING 4, SUITE 2
ROME NY
13440-1900
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-7284
  • Fax: 315-338-7286
Mailing address:
  • Phone: 315-338-7284
  • Fax: 315-338-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANKUR DESAI
Title or Position: PRESIDENT
Credential: MD
Phone: 315-338-7289