=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952465577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT LEWIS ROMEO D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2634 W 30TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-3172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-833-0282
-----------------------------------------------------
Fax | 814-836-0608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4929 W 38TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-838-4636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS022128-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------