Provider Demographics
NPI:1346241155
Name:LOMBARDO, ANTHONY M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12255 DE PAUL DR
Mailing Address - Street 2:SUITE 470
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-739-8863
Mailing Address - Fax:314-739-6448
Practice Address - Street 1:12255 DE PAUL DR
Practice Address - Street 2:SUITE 470
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-739-8863
Practice Address - Fax:314-739-6448
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-03-28
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
MO000551213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO086244OtherEXCLUSIVE CHOICE
MO480034196OtherRR MEDICARE
MO0004388893OtherAETNA
MO2700030OtherUNITED HEALTH CARE
MO083601001OtherMEDICARE DME
MO173863OtherHEALTHLINK
MO9872OtherBLUE CROSS
MO303231500Medicaid
MO4388893OtherMERCY HEALTH PLAN
MO000021530Medicare ID - Type UnspecifiedCPIN #
MO173863OtherHEALTHLINK