Basic Information
| Provider Information | |||||||||
| NPI: | 1932360849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMEO | ||||||||
| FirstName: | COLETTE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TERRY | ||||||||
| OtherFirstName: | COLETTE | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729344392 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 SW 30TH AVE | ||||||||
| Address2: | SUITE 101, DERMPATH DIAGNOSTICS | ||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330694887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003306770 | ||||||||
| FaxNumber: | 9546333217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | MD436150 | PA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | BP10034758 | TX | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | ME108023 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No ID Information.