Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 8654 | SC |
Y | 213ES0000X | Sports Medicine | 8654 | SC |
NPI | 1275063489 |
---|---|
Provider Name | Alexandra Catherine Roemer |
First Address | Columbia, SC 29212-1762 |
Second Address | Columbia, SC 29212-1762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 20/06/2017 |