Provider Demographics
NPI:1689855025
Name:VAN E. LOMIS, MD LLC
Entity Type:Organization
Organization Name:VAN E. LOMIS, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOMIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-687-4004
Mailing Address - Street 1:9106 PHILADELPHIA RD
Mailing Address - Street 2:308
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4329
Mailing Address - Country:US
Mailing Address - Phone:410-687-4004
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD
Practice Address - Street 2:308
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF24312Medicare UPIN
MD954MMedicare PIN