Provider Demographics
NPI:1447493069
Name:ROMM, AVIVA JILL (MD)
Entity type:Individual
Prefix:
First Name:AVIVA
Middle Name:JILL
Last Name:ROMM
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-0085
Mailing Address - Country:US
Mailing Address - Phone:413-591-0543
Mailing Address - Fax:413-362-7435
Practice Address - Street 1:27 W ALFORD ROAD
Practice Address - Street 2:
Practice Address - City:W STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01266
Practice Address - Country:US
Practice Address - Phone:413-591-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9040902207Q00000X
MA253326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine