Basic Information
| Provider Information | |||||||||
| NPI: | 1194847871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMBROSIO | ||||||||
| FirstName: | ROMEO | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 950202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S FLOYD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026291515 | ||||||||
| FaxNumber: | 5026291545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 02/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01064174A | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 41426 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 089399 | 01 | SIHO | OTHER | 200894800 | 05 | IN | MEDICAID | 7100005690 | 05 | KY | MEDICAID | 0101238280 | 01 | VA | LICENSE | OTHER | 3873422 | 01 | KY | CIGNA | OTHER | 50015846 | 01 | KY | PASSPORT (OB/GYN) | OTHER | 2858785000 | 01 | LA | PASSPORT ADVNTG | OTHER | 50016558 | 01 | KY | PASSPORT - PCP | OTHER | 530495 | 01 | KY | ANTHEM | OTHER | 000023028Q | 01 | HUMANA | OTHER | 196290YYY | 01 | IN | MEDICARE - CMA | OTHER |