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General NPI Number Information
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NPI Number | 1356645063
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Entity Type | Individual
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Provider Name | ROMEO PESHKU P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 25 CROSSROADS DR STE 312
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5437
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Country | US
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Telephone | 410-363-6664
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Fax |
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Provider Business Mailing Address
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Address Line | 9457 JOPPA POND RD
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City | BALTIMORE
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State | MD
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Zip | 21234-1362
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Country | US
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Telephone | 410-529-3880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C0004405
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C0004405
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License Number State | MD
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