Provider Demographics
NPI:1134105216
Name:ROMBLAD, JASON S (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:ROMBLAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 EMERGENCY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6804
Mailing Address - Country:US
Mailing Address - Phone:336-249-2978
Mailing Address - Fax:336-249-6748
Practice Address - Street 1:510 EMERGENCY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6804
Practice Address - Country:US
Practice Address - Phone:336-249-2978
Practice Address - Fax:336-249-6748
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104053363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ26410Medicare UPIN
NC2761734AMedicare ID - Type Unspecified