Provider Demographics
NPI:1447523014
Name:JOHN ROMANO MD INC
Entity type:Organization
Organization Name:JOHN ROMANO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-794-5010
Mailing Address - Street 1:39380 CIVIC CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6719
Mailing Address - Country:US
Mailing Address - Phone:510-794-5010
Mailing Address - Fax:510-794-5143
Practice Address - Street 1:39380 CIVIC CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6719
Practice Address - Country:US
Practice Address - Phone:510-794-5010
Practice Address - Fax:510-794-5143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47782208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G477821Medicaid
CA00G477821Medicaid
CA00G477820Medicare PIN