Provider Demographics
NPI:1629235775
Name:JOHN J LOMONACO MD PA
Entity Type:Organization
Organization Name:JOHN J LOMONACO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOMONACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:713-526-5550
Mailing Address - Street 1:1009 MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2839
Mailing Address - Country:US
Mailing Address - Phone:713-526-5550
Mailing Address - Fax:713-526-5563
Practice Address - Street 1:1009 MISSOURI ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2839
Practice Address - Country:US
Practice Address - Phone:713-526-5550
Practice Address - Fax:713-526-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ60132086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149195301Medicaid
TX00090TMedicare PIN
TX149195301Medicaid