Provider Demographics
NPI:1356645063
Name:PESHKU, ROMEO (PA)
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:
Last Name:PESHKU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9457 JOPPA POND RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1362
Mailing Address - Country:US
Mailing Address - Phone:410-529-3880
Mailing Address - Fax:
Practice Address - Street 1:25 CROSSROADS DR STE 312
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5437
Practice Address - Country:US
Practice Address - Phone:410-363-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004405208600000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical