Basic Information
| Provider Information | |||||||||
| NPI: | 1083962443 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROME MEDICAL PRACTICE P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UPSTATE UROLOGY OF ROME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 BLACK RIVER BLVD N | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134402451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153370429 | ||||||||
| FaxNumber: | 3153560583 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 E CHESTNUT ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134402834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153567390 | ||||||||
| FaxNumber: | 3153567393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2012 | ||||||||
| LastUpdateDate: | 08/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | PATRICK | ||||||||
| AuthorizedOfficialFirstName: | CHESTER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3153360250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.