Provider Demographics
NPI:1225397896
Name:ROMANO DELANGE, CATHERINE C (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:ROMANO DELANGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:C
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:PAYER CREDENTIALING
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-773-2559
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:1200 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3118
Practice Address - Country:US
Practice Address - Phone:928-214-2920
Practice Address - Fax:928-214-2925
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2353207R00000X
AZ006404207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ927004Medicaid
MNH400098069Medicare PIN
AZZ169695Medicare PIN