Provider Demographics
NPI:1780697086
Name:ROMAIN-TYSON, ROSEMARIE A (MD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARIE
Middle Name:A
Last Name:ROMAIN-TYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 W 129 TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-645-2369
Mailing Address - Fax:816-404-8637
Practice Address - Street 1:2211 CHARLOTTE ST
Practice Address - Street 2:TRUMAN MED CT
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2733
Practice Address - Country:US
Practice Address - Phone:816-404-8632
Practice Address - Fax:816-404-8637
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO1189892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H20369Medicare UPIN
447A462Medicare ID - Type Unspecified