Provider Demographics
NPI:1548360928
Name:ROEMER, PAUL B (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:ROEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:759 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3473
Mailing Address - Country:US
Mailing Address - Phone:814-599-8584
Mailing Address - Fax:814-375-9390
Practice Address - Street 1:211 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2517
Practice Address - Country:US
Practice Address - Phone:814-375-9383
Practice Address - Fax:814-375-9390
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067947L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001765984 0008Medicaid
PAH03223Medicare UPIN
PA001765984 0008Medicaid