MEDICARE: ROME MEDICAL GROUP, P.C.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407892342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROME MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	1801 BLACK RIVER BLVD N
Second Line	:
City	:	ROME
State	:	NY
Zip	:	13440-2427
Country	:	US
Telephone Number	:	315-337-3770
Fax Number	:	315-337-7614

Provider Business Practice Location Address
First Line	:	1801 BLACK RIVER BLVD N
Second Line	:
City	:	ROME
State	:	NY
Zip	:	13440-2427
Country	:	US
Telephone Number	:	315-337-3770
Fax Number	:	315-337-7614

Authorized Official
Title or Position	:	INFORMATION SPECIALIST
Name	:	MS. LYNN ANNE VACCARO
Credential	:
Telephone Number	:	315-337-3770

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	06/24/2010

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Directions to “ROME MEDICAL GROUP, P.C. ” Practice Location

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