MEDICARE: ROMELLO LAQUAN DAVON NORTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	VM557804	OH

General Provider Information

NPI Number	:	1104610211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMELLO LAQUAN DAVON NORTON

Provider Business Mailing Address
First Line	:	6408 CARL AVE
Second Line	:	3
City	:	CLEVELAND
State	:	OH
Zip	:	44103
Country	:	US
Telephone Number	:	216-820-0825
Fax Number	:

Provider Business Practice Location Address
First Line	:	6408 CARL AVE
Second Line	:	2
City	:	CLEVELAND
State	:	OH
Zip	:	44103
Country	:	US
Telephone Number	:	216-820-0825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2025
Last Update Date	:	04/05/2025

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