Provider Demographics
NPI:1467419572
Name:ROMANO, EUGENE JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOHN
Last Name:ROMANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1786C COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9508
Practice Address - Country:US
Practice Address - Phone:717-684-3663
Practice Address - Fax:717-684-9030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S002455L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000641392Medicaid
PA000641392Medicaid
PA041749Medicare ID - Type Unspecified