Basic Information
| Provider Information | |||||||||
| NPI: | 1184266561 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANDREW M. ROMANOWSKY MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 BARTLETT ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018521317 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 BARTLETT ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018521317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784581293 | ||||||||
| FaxNumber: | 9784586953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2019 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROMANOWSKY | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 9784581293 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110102144A | 05 | MA | MEDICAID |