Provider Demographics
NPI:1649386301
Name:LOMBARD, DAVID ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:LOMBARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 MIAMISBURG-CENTERVILLE RD.
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-435-0730
Mailing Address - Fax:
Practice Address - Street 1:2717 MIAMISBURG-CENTERVILLE RD.
Practice Address - Street 2:SUITE 218
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-435-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311173276OtherAETNA
OH311173276OtherKLAIS & CO., INC.
OH311173276026OtherCARESOURCE
OH0292240Medicaid
OH311173276OtherOHIO MEDICAL MUTUAL
OH311173276OtherHUMANA
OH311173276OtherUNITED HEALTHCARE
OH311173276OtherGREAT-WEST
OH000000285269OtherANTHEM
OH311173276OtherUNITED MEDICAL RESOURCES
OH311173276OtherKLAIS & CO., INC.
OHCP21041Medicare PIN