Provider Demographics
NPI:1073210811
Name:LOMIBAO MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:LOMIBAO MEDICAL PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMIBAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-716-4437
Mailing Address - Street 1:195 ALVORD PARK RD
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3414
Mailing Address - Country:US
Mailing Address - Phone:860-716-4437
Mailing Address - Fax:
Practice Address - Street 1:195 ALVORD PARK RD
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3414
Practice Address - Country:US
Practice Address - Phone:860-716-4437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty