Provider Demographics
NPI:1407892342
Name:ROME MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ROME MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INFORMATION SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-337-3770
Mailing Address - Street 1:1801 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2427
Mailing Address - Country:US
Mailing Address - Phone:315-337-3770
Mailing Address - Fax:315-337-7614
Practice Address - Street 1:1801 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2427
Practice Address - Country:US
Practice Address - Phone:315-337-3770
Practice Address - Fax:315-337-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01511013Medicaid
NY01511013Medicaid