Provider Demographics
NPI:1558535294
Name:MEERA P LOBO MD PC
Entity Type:Organization
Organization Name:MEERA P LOBO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-471-4645
Mailing Address - Street 1:9 LIVINGSTON ST
Mailing Address - Street 2:MARY TOWER BUILDING STE 3S
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4719
Mailing Address - Country:US
Mailing Address - Phone:845-471-4645
Mailing Address - Fax:845-485-3528
Practice Address - Street 1:9 LIVINGSTON ST
Practice Address - Street 2:MARY TOWER BUILDING STE 3S
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4719
Practice Address - Country:US
Practice Address - Phone:845-471-4645
Practice Address - Fax:845-485-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197252207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01532585Medicaid
NY33D1020163OtherCLIA
NYWEP411Medicare PIN