1235303264 NPI number — CALVARY MEDICAL CLINIC PA

Table of content: DR. MADELINE L. ROMEU O.D. (NPI 1235125113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235303264 NPI number — CALVARY MEDICAL CLINIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALVARY MEDICAL CLINIC 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:
1235303264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 79029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28271-7046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-979-8210
Provider Business Mailing Address Fax Number:
877-492-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
537 W SUGAR CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28213-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-979-8210
Provider Business Practice Location Address Fax Number:
877-492-8881
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MARFO
Authorized Official First Name:
MAGDALENE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-979-8210

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2001-01471 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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