Provider Demographics
NPI:1669426219
Name:KROME, CHARLES NICHOLAS (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:KROME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1776
Mailing Address - Country:US
Mailing Address - Phone:609-927-1991
Mailing Address - Fax:609-926-0075
Practice Address - Street 1:24 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1776
Practice Address - Country:US
Practice Address - Phone:609-927-1991
Practice Address - Fax:609-926-0075
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010745-L207QS0010X
NJ25MB07964500207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7618470OtherAETNA PIN
H87313Medicare UPIN
7618470OtherAETNA PIN
NJP00252807Medicare PIN
H87313Medicare UPIN
NJ1109684OtherAETNA