Provider Demographics
NPI:1689765059
Name:LOMIS, VAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:E
Last Name:LOMIS
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 1:1519 STONE POST CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5818
Mailing Address - Country:US
Mailing Address - Phone:410-638-7208
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4329
Practice Address - Country:US
Practice Address - Phone:410-687-4004
Practice Address - Fax:410-687-1736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD954M757FMedicare ID - Type UnspecifiedMEDICARE NUMBER
MDF24312Medicare UPIN