Provider Demographics
NPI:1174530299
Name:WAGHMARAE, ROMANTH
Entity type:Individual
Prefix:DR
First Name:ROMANTH
Middle Name:
Last Name:WAGHMARAE
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 1:6245 SHERIDAN DR
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4834
Mailing Address - Country:US
Mailing Address - Phone:716-505-1500
Mailing Address - Fax:716-408-3210
Practice Address - Street 1:6245 SHERIDAN DR
Practice Address - Street 2:SUITE 116
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4834
Practice Address - Country:US
Practice Address - Phone:716-505-1500
Practice Address - Fax:716-408-3210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171388207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3494Medicare UPIN