Provider Demographics
NPI:1548498454
Name:EROMO, ERSNO (MD)
Entity type:Individual
Prefix:DR
First Name:ERSNO
Middle Name:
Last Name:EROMO
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 1:1400 S GRAND AVE STE 707
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2881
Mailing Address - Country:US
Mailing Address - Phone:310-929-6336
Mailing Address - Fax:877-797-3623
Practice Address - Street 1:1400 S GRAND AVE STE 707
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2881
Practice Address - Country:US
Practice Address - Phone:310-929-6336
Practice Address - Fax:877-797-3623
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238499207X00000X
CAC145666207X00000X
KYTP298207XS0117X
KY43786207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000675679OtherNLS/ANTHEM
KY675679OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KY50024957OtherPASPORT- NORTON LEATHERMAN SPINE CENTER
IN200993270Medicaid
KY000052155WOtherHUMANA- NORTON LEATHERMAN SPINE CENTER
118050OtherNLS/SIHO
KY118050OtherSIHO- NORTON LEATHERMAN SPINE CENTER
KY7100130210Medicaid
50024957OtherNLS/PHP
KY9567569OtherAETNA- NORTON LEATHERMAN SPINE CENTER
000000675679OtherNLS/ANTHEM