Provider Demographics
NPI:1912295445
Name:ROMERO, FABIAN ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:FABIAN
Middle Name:ANDRES
Last Name:ROMERO
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 1:4922 LASALLE RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3302
Mailing Address - Country:US
Mailing Address - Phone:301-277-6310
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2096
Practice Address - Country:US
Practice Address - Phone:310-453-0419
Practice Address - Fax:310-829-1960
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD81370207R00000X
MDD0081370207RI0200X
390200000X
CAA162848207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program