Provider Demographics
NPI:1275588253
Name:LOMOTAN, LUCIA THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:THERESA
Last Name:LOMOTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:LOMOTAN
Other - Last Name:NEMOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 CATHEDRAL STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:
Practice Address - Street 1:1001 CATHEDRAL STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD60347207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD620888-01OtherBLUE CROSS/BLUE SHIELD
MD402228900Medicaid
DE1275588253Medicaid
MD620888-01OtherBLUE CROSS/BLUE SHIELD
MDG164Medicare PIN
MD402228900Medicaid