Provider Demographics
NPI:1205846482
Name:ROMANICK, PETER CHARLES SR (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHARLES
Last Name:ROMANICK
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P
Other - Middle Name:CHARLES
Other - Last Name:ROMANICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:204 WEST WINDCREST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4408
Mailing Address - Country:US
Mailing Address - Phone:830-997-4043
Mailing Address - Fax:830-997-0301
Practice Address - Street 1:204 WEST WINDCREST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4408
Practice Address - Country:US
Practice Address - Phone:830-997-4043
Practice Address - Fax:830-997-0301
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120165902Medicaid
TX0609710001Medicare NSC
TXD67679Medicare UPIN
TX8K5389Medicare PIN