Healthcare Provider Details

I. General information

NPI: 1205128238
Provider Name (Legal Business Name): ROME MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 N JAMES ST SUITE 700
ROME NY
13440-2852
US

IV. Provider business mailing address

1617 N JAMES ST SUITE 700
ROME NY
13440-2852
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-0202
  • Fax: 315-337-8188
Mailing address:
  • Phone: 315-337-0202
  • Fax: 315-337-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WALEED ALBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 315-338-7232