1215061023 NPI number — ROMULO J CAMOGLIANO MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215061023 NPI number — ROMULO J CAMOGLIANO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMULO J CAMOGLIANO MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1215061023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N US HIGHWAY 441
Provider Second Line Business Mailing Address:
BLDG.900 STE.902
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32159-8975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-259-3435
Provider Business Mailing Address Fax Number:
352-259-3438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 N US HIGHWAY 441
Provider Second Line Business Practice Location Address:
BLDG.900 STE.902
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-8975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-259-3435
Provider Business Practice Location Address Fax Number:
352-259-3438
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAMOGLIANO
Authorized Official First Name:
ROMULO
Authorized Official Middle Name:
JUAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-259-3435

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME68972 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27691 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0400644 . This is a "BC/BS HEALTH CHOICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 378533500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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