Provider Demographics
NPI:1447338314
Name:ROMANO, TERESA L (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:ROMANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:2825 LIVERNOIS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-528-2310
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:2825 LIVERNOIS
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-528-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI051366207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI266315610Medicaid
TR051366OtherCHAMPUS-CHAMPUS
700H262200OtherBLUE CROSS-BLUE CROSS
TR051366OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26220041Medicare ID - Type Unspecified
MI266315610Medicaid