Healthcare Provider Details

I. General information

NPI: 1225070915
Provider Name (Legal Business Name): ROMEO WILDON LAROYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILDON LAROYA M.D.

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SOUTH BELMONT STREET
YORK PA
17405
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 800-436-4326
  • Fax: 703-563-6256
Mailing address:
  • Phone: 571-777-5102
  • Fax: 703-563-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-30720
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD423062
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number04-30720
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number04-30720
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: