Provider Demographics
NPI:1548978737
Name:TRABOLSKY, ROMI
Entity type:Individual
Prefix:
First Name:ROMI
Middle Name:
Last Name:TRABOLSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HEATH ST APT 63
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-3135
Mailing Address - Country:US
Mailing Address - Phone:843-446-9005
Mailing Address - Fax:
Practice Address - Street 1:1130 GODWIN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-6828
Practice Address - Country:US
Practice Address - Phone:252-789-0401
Practice Address - Fax:252-789-0452
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant