Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 47024 | MA |
NPI | 1124025184 |
---|---|
Provider Name | Loyde H Romero |
First Address | Medford, MA 02155-3201 |
Second Address | Medford, MA 02155-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0126845 | (05) | MA |
A54733 | (02) | |
E05241 | BCBS (01) | MA |