Provider Demographics
NPI:1467698225
Name:ROMESBURG, KRISTEN S (DO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:S
Last Name:ROMESBURG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:SCALISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1263 STATE ROUTE 40 W
Mailing Address - Street 2:PO BOX N
Mailing Address - City:CLAYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15323-1277
Mailing Address - Country:US
Mailing Address - Phone:724-663-7731
Mailing Address - Fax:724-663-9022
Practice Address - Street 1:1263 STATE ROUTE 40 W
Practice Address - Street 2:PO BOX N
Practice Address - City:CLAYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15323-1277
Practice Address - Country:US
Practice Address - Phone:724-663-7731
Practice Address - Fax:724-663-9022
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074430OtherMEDICARE GROUP PTAN
PA001526106OtherHIGHMARK GROUP NUMBER
PA1024870700002Medicaid
PA1184675035OtherGROUP NPI NUMBER
PA001526106OtherHIGHMARK GROUP NUMBER
PA186259R7FMedicare PIN
PA281696OtherUNISON
PACA8890OtherGROUP PTAN