Provider Demographics
NPI:1497774434
Name:ROMICK, BENJAMIN G (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:ROMICK
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-537-8600
Mailing Address - Fax:415-369-1371
Practice Address - Street 1:1100 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3215
Practice Address - Country:US
Practice Address - Phone:415-537-8600
Practice Address - Fax:415-369-1371
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18196207RC0000X
NY252877207RC0000X
CAA114506207RC0000X
LA301871207RI0011X
CA786894207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA114506OtherSTATE MEDICAL LICENSE
LA2430840Medicaid
LA532770YH3UMedicare PIN
MS00527058Medicaid