Provider Demographics
NPI:1215061023
Name:ROMULO J CAMOGLIANO MD PA
Entity type:Organization
Organization Name:ROMULO J CAMOGLIANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMULO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:CAMOGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-259-3435
Mailing Address - Street 1:1400 N US HIGHWAY 441
Mailing Address - Street 2:BLDG.900 STE.902
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8975
Mailing Address - Country:US
Mailing Address - Phone:352-259-3435
Mailing Address - Fax:352-259-3438
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:BLDG.900 STE.902
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-259-3435
Practice Address - Fax:352-259-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27691OtherBC/BS
FL0400644OtherBC/BS HEALTH CHOICE
FL378533500Medicaid
FL0400644OtherBC/BS HEALTH CHOICE
FL27691WMedicare UPIN