Provider Demographics
NPI:1760439384
Name:MARK ROMANOWSKY MD PC
Entity Type:Organization
Organization Name:MARK ROMANOWSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-458-1293
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:241 PAWTUCKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3501
Practice Address - Country:US
Practice Address - Phone:978-458-1293
Practice Address - Fax:978-458-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9728651Medicaid
MAM13906OtherBLUE CROSS BLUE SHIELD
MAM13906Medicare ID - Type Unspecified