Provider Demographics
NPI:1003251083
Name:MD TRANSFORMATIONS LLC
Entity Type:Organization
Organization Name:MD TRANSFORMATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-283-5668
Mailing Address - Street 1:50 CYPRESS POINT PKWY STE B1
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2501
Mailing Address - Country:US
Mailing Address - Phone:386-283-5668
Mailing Address - Fax:386-283-5670
Practice Address - Street 1:50 CYPRESS POINT PKWY STE B1
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2501
Practice Address - Country:US
Practice Address - Phone:386-283-5668
Practice Address - Fax:386-283-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty