Provider Demographics
NPI:1376587576
Name:LOBO, VINCENT G (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:G
Last Name:LOBO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:BETHANY BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19930-1036
Mailing Address - Country:US
Mailing Address - Phone:302-242-6352
Mailing Address - Fax:
Practice Address - Street 1:205 SHAW AVE
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-1220
Practice Address - Country:US
Practice Address - Phone:302-398-8704
Practice Address - Fax:302-398-8818
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0000334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4363549OtherAETNA PPO
DE66481OtherBCBSDE
DE3870195OtherCIGNA
DE3778895OtherAETNA HMO
DE2369122000OtherAMERIHEALTH
DEP00225770OtherPALMETTO
DE202298856OtherCOVENTRY
DE202298856OtherUNITED HEALTH CARE
DE1000035903Medicaid
DE1000035903Medicaid
DE3778895OtherAETNA HMO
DE1000035903Medicaid