Provider Demographics
NPI:1639372147
Name:BOMELI, STEVEN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:BOMELI
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 1:960 JOHNSON FY RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-943-0900
Mailing Address - Fax:404-943-1390
Practice Address - Street 1:960 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1631
Practice Address - Country:US
Practice Address - Phone:404-943-0900
Practice Address - Fax:404-943-1390
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071097207Y00000X, 207Y00000X, 390200000X
PAMT189359390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01027663OtherMEDICARE RAILROAD
NC5917792Medicaid
NC1629781OtherCIGNA
GA071097OtherGA LICENSE
NC164XKOtherBCBSNC
SC30099942OtherSELECT HEALTH OF SC
NC9219664OtherAETNA
SCNC1403Medicaid
NCNC0493AMedicare PIN