Basic Information
| Provider Information | |||||||||
| NPI: | 1649316613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROEMMICH | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 VERDAE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296074021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642720388 | ||||||||
| FaxNumber: | 8642139237 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 HARRISON BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SIMPSONVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296807133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642720388 | ||||||||
| FaxNumber: | 8642139237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 02/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 57999 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 28215 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 282152 | 05 | SC | MEDICAID | 576007863102 | 01 | SC | BCBS | OTHER |