Healthcare Provider Details

I. General information

NPI: 1932181906
Provider Name (Legal Business Name): ANDREW ROMANOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 NW NORTHRUP ST
PORTLAND OR
97209-1614
US

IV. Provider business mailing address

PO BOX 22009
PORTLAND OR
97269-2009
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-2020
  • Fax: 503-222-0614
Mailing address:
  • Phone: 503-558-7372
  • Fax: 503-344-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD13918
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: