Provider Demographics
NPI:1689819112
Name:ROMERO, PHOEBE CM (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PHOEBE
Middle Name:CM
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 EASTHAM BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1374
Mailing Address - Country:US
Mailing Address - Phone:615-939-2015
Mailing Address - Fax:
Practice Address - Street 1:136 BERLIN RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2627
Practice Address - Country:US
Practice Address - Phone:860-378-8585
Practice Address - Fax:860-378-8586
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1411363A00000X
MO2011010509363A00000X
CT3223363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant