Healthcare Provider Details

I. General information

NPI: 1104853423
Provider Name (Legal Business Name): NICHOLAS M ROMANO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S 2ND ST
BANGOR PA
18013-2504
US

IV. Provider business mailing address

104 S 2ND ST
BANGOR PA
18013-2504
US

V. Phone/Fax

Practice location:
  • Phone: 610-588-3133
  • Fax: 610-588-5138
Mailing address:
  • Phone: 610-588-3133
  • Fax: 610-588-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD021161E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: