MEDICARE: DR. MARCUS GREGORY ROMANELLO M.D.

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	207P00000X	Emergency Medicine Physician	35.090166	OH
2	207P00000X	Emergency Medicine Physician	00026492	AL

General Provider Information

NPI Number	:	1366494908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCUS GREGORY ROMANELLO M.D.

Provider Business Mailing Address
First Line	:	1010 LAY DAM RD
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35045-2306
Country	:	US
Telephone Number	:	205-755-2500
Fax Number	:	205-280-3569

Provider Business Practice Location Address
First Line	:	1010 LAY DAM RD
Second Line	:
City	:	CLANTON
State	:	AL
Zip	:	35045-2306
Country	:	US
Telephone Number	:	205-755-2500
Fax Number	:	205-280-3569

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/05/2023

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