Provider Demographics
NPI:1679555452
Name:SHOMBERT, LAWRENCE P (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:SHOMBERT
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 1:12500 WILLOWBROOK RD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6393
Mailing Address - Country:US
Mailing Address - Phone:240-964-1400
Mailing Address - Fax:240-964-1490
Practice Address - Street 1:12500 WILLOWBROOK RD DEPT OF
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-1400
Practice Address - Fax:240-964-1490
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.00162222085R0001X
MDD439142085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019575Medicaid
MD6882-0001OtherCAREFIRST BCBS- DC
MD52981008OtherCARE FIRST BCBS PROV. #
WVP00894865OtherRAILROAD MEDICARE
MD0001OtherBCBS DC
MDP00441743OtherRAILROAD MEDICARE #
MDP00458397OtherRAILROAD MEDICARE
MD213391100Medicaid
MD5273OtherELDER HEALTH PROVIDER #
MD529810-09OtherBCBS MD
DC038445300Medicaid
MDE65227Medicare UPIN
MD213391100Medicaid
MD52981008OtherCARE FIRST BCBS PROV. #
WVP00894865OtherRAILROAD MEDICARE