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General NPI Number Information
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NPI Number | 1982279675
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Entity Type | Individual
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Provider Name | ANDREW SCOTT ROMAINE PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 4103 MERCANTILE DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2556
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Country | US
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Telephone | 503-850-9940
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Fax |
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Provider Business Mailing Address
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Address Line | 1646 NE 17TH AVE
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City | CANBY
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State | OR
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Zip | 97013-2369
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Country | US
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Telephone |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA212094
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License Number State | OR
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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 | 5319
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License Number State | CT
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