Provider Demographics
NPI:1225070915
Name:LAROYA, ROMEO WILDON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:WILDON
Last Name:LAROYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILDON
Other - Middle Name:
Other - Last Name:LAROYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3309
Mailing Address - Country:US
Mailing Address - Phone:571-777-5102
Mailing Address - Fax:703-563-6256
Practice Address - Street 1:325 SOUTH BELMONT STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17405
Practice Address - Country:US
Practice Address - Phone:800-436-4326
Practice Address - Fax:703-563-6256
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30720207L00000X, 207LC0200X, 207LP2900X
PAMD423062207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200267570AMedicaid
KS104002OtherBCBS OF KANSAS
KS200267570AMedicaid