Provider Demographics
NPI:1164867347
Name:VASQUEZ, ROMULO V (MD)
Entity type:Individual
Prefix:
First Name:ROMULO
Middle Name:V
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8904
Mailing Address - Country:US
Mailing Address - Phone:203-276-2472
Mailing Address - Fax:203-276-4594
Practice Address - Street 1:170 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8904
Practice Address - Country:US
Practice Address - Phone:203-276-2472
Practice Address - Fax:203-276-4594
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53485207PS0010X, 207Q00000X
NY272256207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine