Provider Demographics
NPI:1366611436
Name:STEPHEN C. ROMAGNOLO, M.D., L.L.C.
Entity type:Organization
Organization Name:STEPHEN C. ROMAGNOLO, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROMAGNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-416-7888
Mailing Address - Street 1:PO BOX 6041
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-6041
Mailing Address - Country:US
Mailing Address - Phone:813-416-7888
Mailing Address - Fax:
Practice Address - Street 1:1304 OHIO AVE S
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4156
Practice Address - Country:US
Practice Address - Phone:386-364-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty