Provider Demographics
NPI:1356512529
Name:P CHARLES ROMANICK MD PA
Entity type:Organization
Organization Name:P CHARLES ROMANICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROMANICK
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:830-997-4043
Mailing Address - Street 1:204 WEST WINDCREST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4408
Mailing Address - Country:US
Mailing Address - Phone:830-997-4043
Mailing Address - Fax:830-997-0301
Practice Address - Street 1:204 WEST WINDCREST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4408
Practice Address - Country:US
Practice Address - Phone:830-997-4043
Practice Address - Fax:830-997-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2215207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QY11Medicare PIN
TX0609710001Medicare NSC