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General NPI Number Information
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NPI Number | 1205128238
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Entity Type | Organization
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Legal Business Name | ROME MEDICAL PRACTICE
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 1617 N JAMES ST SUITE 700
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City | ROME
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State | NY
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Zip | 13440-2852
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Country | US
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Telephone | 315-337-0202
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Fax | 315-337-8188
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Provider Business Mailing Address
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Address Line | 1617 N JAMES ST SUITE 700
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City | ROME
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State | NY
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Zip | 13440-2852
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Country | US
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Telephone | 315-337-0202
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Fax | 315-337-8188
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALEED ALBERT
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Credential | MD
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Telephone | 315-338-7232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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