Provider Demographics
NPI:1427014869
Name:ROMAC, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:ROMAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SCHOONER STREET
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4047
Mailing Address - Country:US
Mailing Address - Phone:207-563-4777
Mailing Address - Fax:207-563-4738
Practice Address - Street 1:79 SCHOONER STREET
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-4777
Practice Address - Fax:207-563-4738
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY189731-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003889Medicaid
NY01374818Medicaid
NYBB8759Medicare ID - Type Unspecified
VTVN064701Medicare PIN
VT1003889Medicaid