Provider Demographics
NPI:1275524365
Name:LOMO, LESLEY CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:CAROL
Last Name:LOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PATHOLOGY MSC 08 4640
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-0995
Mailing Address - Fax:505-272-2963
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-0995
Practice Address - Fax:505-272-2963
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA223640207ZP0102X
NMMD2007-0585207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI60890Medicare UPIN