Provider Demographics
NPI:1417090044
Name:WADHAWAN, ROMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMIL
Middle Name:
Last Name:WADHAWAN
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 1:1010 S SCHEUBER RD
Mailing Address - Street 2:SUITE 3&4
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-8892
Mailing Address - Country:US
Mailing Address - Phone:360-807-7966
Mailing Address - Fax:360-807-7977
Practice Address - Street 1:1010 S SCHEUBER RD
Practice Address - Street 2:SUITE 3&4
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-8892
Practice Address - Country:US
Practice Address - Phone:360-807-7966
Practice Address - Fax:360-807-7977
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP20423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA231656OtherLABOR AND INDUSTRY
WA8505315Medicaid
WA8946725OtherLABOR AND INDUSTRY CRIME VICTIM