Provider Demographics
NPI:1417919101
Name:LOMBOY, CARL TRINIDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:TRINIDAD
Last Name:LOMBOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PERPETUAL SQ
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1713
Mailing Address - Country:US
Mailing Address - Phone:864-261-7474
Mailing Address - Fax:864-261-8581
Practice Address - Street 1:100 PERPETUAL SQ
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1713
Practice Address - Country:US
Practice Address - Phone:864-261-7474
Practice Address - Fax:864-261-8581
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ36761Medicaid
NC8952539Medicaid
SCP00869101OtherRR MEDICARE
NC52539OtherBCBS OF NC PROVIDER ID#
NCC34784Medicare UPIN
SC8515Medicare PIN
NC2187781BMedicare PIN