Provider Demographics
NPI:1275592917
Name:ROMANO-CLARKE, GIUSEPPINA (MD)
Entity Type:Individual
Prefix:
First Name:GIUSEPPINA
Middle Name:
Last Name:ROMANO-CLARKE
Suffix:
Gender:F
Credentials:MD
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 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-9042
Mailing Address - Fax:617-726-9346
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:FOUNDERS 5-530
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-9042
Practice Address - Fax:617-726-9346
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0198358Medicaid
MAA33772Medicare PIN
MAH59836Medicare UPIN