Provider Demographics
NPI:1437102464
Name:ROMBERG, KLAS D (MD)
Entity Type:Individual
Prefix:
First Name:KLAS
Middle Name:D
Last Name:ROMBERG
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 1:155 MANSUR ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2907
Mailing Address - Country:US
Mailing Address - Phone:978-996-2422
Mailing Address - Fax:
Practice Address - Street 1:155 MANSUR ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2907
Practice Address - Country:US
Practice Address - Phone:978-458-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0364382085R0202X
MA36438208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2024853Medicaid
MAB26209Medicare ID - Type Unspecified
MA2024853Medicaid