Provider Demographics
NPI:1629289681
Name:ROMNEY K. LADERBERG, MD, PC
Entity Type:Organization
Organization Name:ROMNEY K. LADERBERG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMNEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LADERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-387-5185
Mailing Address - Street 1:596 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3743
Mailing Address - Country:US
Mailing Address - Phone:617-387-5185
Mailing Address - Fax:617-387-0827
Practice Address - Street 1:596 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3743
Practice Address - Country:US
Practice Address - Phone:617-387-5185
Practice Address - Fax:617-387-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73767207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA724634OtherTUFTS
MA61618OtherHARVARD PILGRAM
MA3117031Medicaid
MA61618OtherHARVARD PILGRAM
MA3117031Medicaid