Provider Demographics
NPI:1275855678
Name:ROMANO, MARGARET MADDOX (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MADDOX
Last Name:ROMANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MICHELLE
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 E 1ST ST
Mailing Address - Street 2:STE. 303
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-249-6050
Mailing Address - Fax:218-249-6055
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:STE. 303
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-249-7950
Practice Address - Fax:218-249-6055
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant