Provider Demographics
NPI:1639129786
Name:LOMBARDI, SALVATORE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:LOMBARDI
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 1:2292 DALTON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8946
Mailing Address - Country:US
Mailing Address - Phone:931-572-0036
Mailing Address - Fax:931-572-1078
Practice Address - Street 1:2292 DALTON DR
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8946
Practice Address - Country:US
Practice Address - Phone:931-572-0036
Practice Address - Fax:931-572-1078
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17066207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK074181Medicare PIN
TN3020475Medicare ID - Type Unspecified
KYP400021698Medicare PIN
TNA98411Medicare UPIN
KYK074180Medicare PIN
KYP400021697Medicare PIN