Provider Demographics
NPI:1073857397
Name:SPARTANBURG ALLERGY AND ASTHMA P A
Entity Type:Organization
Organization Name:SPARTANBURG ALLERGY AND ASTHMA P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-542-8900
Mailing Address - Street 1:1092 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2247
Mailing Address - Country:US
Mailing Address - Phone:864-542-8900
Mailing Address - Fax:864-542-2954
Practice Address - Street 1:1092 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2247
Practice Address - Country:US
Practice Address - Phone:864-542-8900
Practice Address - Fax:864-542-2954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17136207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF786900281Medicare UPIN