Provider Demographics
NPI:1730145038
Name:ROMANIC, BRUCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:ROMANIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:119 NEVADA DR
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1957
Practice Address - Country:US
Practice Address - Phone:570-373-1250
Practice Address - Fax:570-373-1718
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031737E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001201531Medicaid
PA603499Medicare ID - Type Unspecified
D25578Medicare UPIN