Provider Demographics
NPI:1366649766
Name:NORTHEAST FLORIDA CARDIOLOGY PA
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-347-9204
Mailing Address - Street 1:5000 US HIGHWAY 17
Mailing Address - Street 2:SUITE 18 #288
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8231
Mailing Address - Country:US
Mailing Address - Phone:904-347-9204
Mailing Address - Fax:386-326-1592
Practice Address - Street 1:6710 OLD WOLF BAY RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6830
Practice Address - Country:US
Practice Address - Phone:386-326-1590
Practice Address - Fax:386-326-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty