Provider Demographics
NPI:1467295915
Name:WALTERS, ROMARO LAMONT JR
Entity type:Individual
Prefix:MR
First Name:ROMARO
Middle Name:LAMONT
Last Name:WALTERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 MCBRIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1514
Mailing Address - Country:US
Mailing Address - Phone:216-466-3159
Mailing Address - Fax:
Practice Address - Street 1:5225 MCBRIDE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1514
Practice Address - Country:US
Practice Address - Phone:216-466-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor