Provider Demographics
NPI:1447226006
Name:LOBO, MELVYN A (MD)
Entity Type:Individual
Prefix:
First Name:MELVYN
Middle Name:A
Last Name:LOBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1960 POINTE WEST DR
Mailing Address - Street 2:SUITES 101 & 102
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1302
Mailing Address - Country:US
Mailing Address - Phone:772-564-7828
Mailing Address - Fax:772-564-6107
Practice Address - Street 1:1960 POINTE WEST DR
Practice Address - Street 2:SUITES 101 & 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1302
Practice Address - Country:US
Practice Address - Phone:772-564-7828
Practice Address - Fax:772-564-6107
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223096-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070109000001OtherFIDELIS
NY000499349004OtherBSNENY
NY5780B1OtherEMPIRE BC
NY7692511OtherAETNA
NY114977OtherGHI/HMO
NY10059187OtherCDPHP
NY02495123Medicaid
NY200104OtherSENIOR WHOLE HEALTH
NY4151243OtherMVP
NYRB1388Medicare PIN
NY5780B1OtherEMPIRE BC