Provider Demographics
NPI:1376645549
Name:ROMZICK, TERESA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:ROMZICK
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 1:2341 SIMONTON RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8246
Mailing Address - Country:US
Mailing Address - Phone:704-761-2400
Mailing Address - Fax:704-761-2399
Practice Address - Street 1:2341 SIMONTON RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8246
Practice Address - Country:US
Practice Address - Phone:704-761-2400
Practice Address - Fax:704-761-2399
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59247207Q00000X
NC9400625208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC187631OtherMEDCOST
NCP00655019OtherRR MEDICARE NC
NC8973065Medicaid
NCD30646Medicare UPIN
NC2252315BMedicare PIN
SC187631OtherMEDCOST