Provider Demographics
NPI:1659389013
Name:TENGCO, ROMULO C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMULO
Middle Name:C
Last Name:TENGCO
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 1:2300 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2240
Mailing Address - Country:US
Mailing Address - Phone:915-562-3444
Mailing Address - Fax:915-875-8854
Practice Address - Street 1:2300 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2240
Practice Address - Country:US
Practice Address - Phone:915-562-3444
Practice Address - Fax:915-875-8854
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA42862207Q00000X
TXN4793207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5208203Medicaid
NJ7475004Medicaid
F34490Medicare UPIN
NJ7475004Medicaid