Provider Demographics
NPI:1225675945
Name:ROMERO PABON, ARDEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ARDEL
Middle Name:JOSE
Last Name:ROMERO PABON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARDEL
Other - Middle Name:JOSE
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1620 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1613
Mailing Address - Country:US
Mailing Address - Phone:617-732-6273
Mailing Address - Fax:
Practice Address - Street 1:1620 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-1613
Practice Address - Country:US
Practice Address - Phone:617-732-6273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT219530207R00000X
PAMD480396390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine