Provider Demographics
NPI:1477545432
Name:ROMO, SUSAN (DO)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:ROMO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7794 RHEA COUNTY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-5981
Mailing Address - Country:US
Mailing Address - Phone:423-775-4261
Mailing Address - Fax:423-570-2008
Practice Address - Street 1:7794 RHEA COUNTY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5981
Practice Address - Country:US
Practice Address - Phone:423-775-4261
Practice Address - Fax:423-570-2008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3339242Medicaid
A15914Medicare UPIN
TN3339242Medicaid