Provider Demographics
NPI:1013996891
Name:ROMEO, ANTHONY A (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:ROMEO
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 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:267-592-6191
Mailing Address - Fax:
Practice Address - Street 1:176 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:800-321-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086761207X00000X
NY294351207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633878OtherBCBS GROUP ID#
ILP00091910OtherRR MEDICARE ID#
IL4379278OtherAETNA ID#
IL036086761 2Medicaid
IL207067OtherMEDICARE PTAN LOCALITY 16
IL207073OtherMEDICARE PTAN LOCALITY 15
ILDA4902OtherRR MEDICARE PTAN#
ILDA4902OtherRR MEDICARE PTAN#
IL1633878OtherBCBS GROUP ID#
ILK01339Medicare PIN