Provider Demographics
NPI:1326002668
Name:LADERBERG, ROMNEY KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:ROMNEY
Middle Name:KENNETH
Last Name:LADERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3743
Mailing Address - Country:US
Mailing Address - Phone:617-387-5185
Mailing Address - Fax:617-387-0827
Practice Address - Street 1:596 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3743
Practice Address - Country:US
Practice Address - Phone:617-387-5185
Practice Address - Fax:617-387-0827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73767207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA724634OtherTUFTS HEALTHCARE
MA3117031Medicaid
MA61618OtherHARVARD PILGRAM HEALTHCAR
MAJ13623OtherBLUE CROSS BLUE SHIELD OF
MAJ13623OtherBLUE CROSS BLUE SHIELD OF
MAF52039Medicare UPIN