Provider Demographics
NPI:1568400554
Name:ROMEO, MARTHA S (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:ROMEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BARRACUDA LN
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-3733
Mailing Address - Country:US
Mailing Address - Phone:305-367-2600
Mailing Address - Fax:305-367-4573
Practice Address - Street 1:50 BARRACUDA LN
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3733
Practice Address - Country:US
Practice Address - Phone:305-367-2600
Practice Address - Fax:305-367-4573
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18251207R00000X
FLME116824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110211282OtherRAILROAD PTAN
WV001718983OtherBLUE CROSS BLUE SHIELD
FL0806833Medicare PIN
WV001718983OtherBLUE CROSS BLUE SHIELD