Provider Demographics
NPI:1104853423
Name:ROMANO, NICHOLAS M JR (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:M
Last Name:ROMANO
Suffix:JR
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 1:104 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-2504
Mailing Address - Country:US
Mailing Address - Phone:610-588-3133
Mailing Address - Fax:610-588-5138
Practice Address - Street 1:104 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-2504
Practice Address - Country:US
Practice Address - Phone:610-588-3133
Practice Address - Fax:610-588-5138
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021161E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01597601OtherCAPITAL BLUE CROSS
PA124304OtherBLUE SHIELD
C30886Medicare UPIN
PA124304Medicare ID - Type Unspecified