1194847871 NPI number — ROMEO S. AMBROSIO M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194847871 NPI number — ROMEO S. AMBROSIO M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

AMBROSIO

Provider First Name:

ROMEO

Provider Middle Name:

S.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1194847871

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/06/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 950202

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

LOUISVILLE

Provider Business Mailing Address State Name:

KY

Provider Business Mailing Address Postal Code:

40295-0202

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

502-588-9490

Provider Business Mailing Address Fax Number:

502-272-5116

Provider First Line Business Practice Location Address:

601 S FLOYD ST

Provider Second Line Business Practice Location Address:

SUITE 300

Provider Business Practice Location Address City Name:

LOUISVILLE

Provider Business Practice Location Address State Name:

KY

Provider Business Practice Location Address Postal Code:

40202-1835

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

502-629-1515

Provider Business Practice Location Address Fax Number:

502-629-1545

Provider Enumeration Date:

04/04/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207V00000X , with the licence number:  01064174A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207V00000X , with the licence number: 41426 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 089399 . This is a "SIHO" identifier . This identifiers is of the category "OTHER".
• Identifier: 200894800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 7100005690 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 0101238280 . This is a "LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 3873422 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 50015846 . This is a "PASSPORT (OB/GYN)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 2858785000 . This is a "PASSPORT ADVNTG" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
• Identifier: 50016558 . This is a "PASSPORT - PCP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 530495 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 000023028Q . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
• Identifier: 196290YYY . This is a "MEDICARE - CMA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".