Provider Demographics
NPI:1134325178
Name:ROMANO, RAYMOND V (DO)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:V
Last Name:ROMANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:219 BATESVILLE ROAD
Practice Address - Street 2:THE OAKS AT FIVE FORKS -
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4816
Practice Address - Country:US
Practice Address - Phone:864-849-9170
Practice Address - Fax:864-849-9193
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1070207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC010703Medicaid
SCSC92973365Medicare PIN
SC010703Medicaid
SCAA52795019Medicare PIN
SCAA52796067Medicare PIN