Healthcare Provider Details

I. General information

NPI: 1134325178
Provider Name (Legal Business Name): RAYMOND V ROMANO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BATESVILLE ROAD THE OAKS AT FIVE FORKS -
SIMPSONVILLE SC
29681-4816
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-849-9170
  • Fax: 864-849-9193
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1070
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1070
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: