Basic Information
| Provider Information | |||||||||
| NPI: | 1578521761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMANOWSKY | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 33 BARTLETT ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018521317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784581293 | ||||||||
| FaxNumber: | 9784586953 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 BARTLETT ST STE 204 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018521317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784581293 | ||||||||
| FaxNumber: | 9784586953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 43073 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7525 | 01 | MA | HARVARD PILGRIM | OTHER | 0005541 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 0100450 | 01 | MA | UNITED HEALTHCARE | OTHER | 043073 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 20336 | 01 | MA | FALLON COMMUNITY HEALTH | OTHER | 2070987 | 05 | MA | MEDICAID | B26229 | 01 | MA | BLUE CROSS | OTHER | 0101263 | 01 | MA | EVERCARE | OTHER | 92423 | 01 | MA | AETNA | OTHER |