Provider Demographics
NPI:1386643682
Name:ROMANO, ESTEBAN O (MD)
Entity Type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:O
Last Name:ROMANO
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 1:1514 JEFFERSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2750 GAUSE BLVD. EAST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:985-639-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05067R174400000X
LAMD.05067R208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00396218OtherRAILROAD MEDICARE
MS00122890Medicaid
LA1321923Medicaid
MS$$$$$$$$$DOtherBLUE CROSS
LA1321923Medicaid
MS370854YXVBMedicare PIN
LAP00396218OtherRAILROAD MEDICARE
LA558106629Medicare PIN
LA$$$$$$$$$BOtherBLUE CROSS