Provider Demographics
NPI:1861598823
Name:ROMERO, STACY C (PAC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:C
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-378-5010
Mailing Address - Fax:804-378-3264
Practice Address - Street 1:2306 ROBIOUS STATION CIRCLE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-378-3048
Practice Address - Fax:804-378-3264
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001592207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P86006Medicare UPIN
VA005401M69Medicare PIN