Provider Demographics
NPI:1922236181
Name:ROMINE, MEGAN JEAN (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:ROMINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JEAN
Other - Last Name:BARRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746870
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6870
Mailing Address - Country:US
Mailing Address - Phone:515-415-4081
Mailing Address - Fax:
Practice Address - Street 1:4841 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1616
Practice Address - Country:US
Practice Address - Phone:515-415-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8666207R00000X
IA4138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1922236181Medicaid
IAP01141264OtherRR MEDICARE
IA719260523Medicare PIN