Provider Demographics
NPI:1194790816
Name:ROMANO, JERALYN GAMBONE (PA C)
Entity type:Individual
Prefix:
First Name:JERALYN
Middle Name:GAMBONE
Last Name:ROMANO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JERALYN
Other - Middle Name:MARIA
Other - Last Name:GAMBONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA C
Mailing Address - Street 1:100 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1259
Mailing Address - Country:US
Mailing Address - Phone:215-368-2100
Mailing Address - Fax:215-361-4414
Practice Address - Street 1:3839 KRATZ RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-1030
Practice Address - Country:US
Practice Address - Phone:610-489-4878
Practice Address - Fax:610-489-4878
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003042L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24065Medicare UPIN
045329E3TMedicare ID - Type Unspecified