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1376647024 NPI number — STEPHEN CHARLES ROMAGNOLO MD

NPI Number: 1376647024
Health Care Provider/Practitioner: STEPHEN CHARLES ROMAGNOLO MD

Information about “1376647024” NPI (STEPHEN CHARLES ROMAGNOLO MD) exists in 1376647024 in HTML format HTML  |  1376647024 in plain Text format TXT  |  1376647024 in PDF (Portable Document Format) PDF  |  1376647024 in an XML format XML  formats.

NPI Number : 1376647024 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376647024",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROMAGNOLO",
    "FirstName": "STEPHEN",
    "MiddleName": "CHARLES",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6824 SUWANNEE PLAZA LN",
    "SecondLineMailingAddress": "PMB 173",
    "MailingAddressCityName": "LIVE OAK",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32060-7495",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "813-416-7888",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6824 SUWANNEE PLAZA LN",
    "SecondLinePracticeLocationAddress": "PMB 173",
    "PracticeLocationAddressCityName": "LIVE OAK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32060-7495",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "813-416-7888",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/12/2006",
    "LastUpdateDate": "09/05/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "ME91099",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207ND0101X",
          "TaxonomyName": "MOHS-Micrographic Surgery Physician",
          "LicenseNumber": "ME91099",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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