Healthcare Provider Details

I. General information

NPI: 1649316613
Provider Name (Legal Business Name): TODD A ROEMMICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 HARRISON BRIDGE RD
SIMPSONVILLE SC
29680-7133
US

IV. Provider business mailing address

525 VERDAE BLVD STE 200
GREENVILLE SC
29607-4021
US

V. Phone/Fax

Practice location:
  • Phone: 864-272-0388
  • Fax: 864-213-9237
Mailing address:
  • Phone: 864-272-0388
  • Fax: 864-213-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57999
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28215
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: