Provider Demographics
NPI:1093701310
Name:CAMOGLIANO, ROMULO JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMULO
Middle Name:JUAN
Last Name:CAMOGLIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N US HIGHWAY 441
Mailing Address - Street 2:BLDG 900 SUITE 902
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8975
Mailing Address - Country:US
Mailing Address - Phone:352-259-3435
Mailing Address - Fax:352-259-3438
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:BLDG 900 SUITE 902
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-259-3435
Practice Address - Fax:352-259-3438
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-03-07
Deactivation Date:2006-04-05
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
FLME0068972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2596528OtherGHI
FL27691OtherBLUE CROSS & BLUE SHIELD
FLME0068972OtherME LICENSE
FLP2621537OtherOXFORD
FL27691WOtherMEDICARE PTAN
FL110202815OtherRAIL ROAD MEDICARE
FL593591343OtherTAX ID
FL0400644OtherHEALTH CHOICE
FL0400644OtherHEALTH CHOICE
FLBC44594735OtherDEA