Provider Demographics
NPI:1710999198
Name:LOMBARD, TESS KRYSPIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TESS
Middle Name:KRYSPIN
Last Name:LOMBARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PHOENIX AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1418
Mailing Address - Country:US
Mailing Address - Phone:203-756-8021
Mailing Address - Fax:203-596-3085
Practice Address - Street 1:80 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1418
Practice Address - Country:US
Practice Address - Phone:203-756-8021
Practice Address - Fax:203-573-5832
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TINOtherNORTHEAST HEALTH DIRECT
CTP00220769OtherRAILROAD MEDICARE
CTP340749OtherOXFORD HEALTH PLANS
TINOtherFOCUS
TINOtherNATIONAL PROVIDER NETWORK
CT9037810OtherCIGNA
TINOtherPIONEER
TINOtherGREAT WEST
TINOtherFIRST HEALTH/ CCN
TINOtherMULTIPLAN
CT5695R1OtherEMPIRE BC/BS
TINOtherPOMCO
CT010035945CT03OtherANTHEM BC/BS
CT035945OtherCONNECTICARE
CT2V5273OtherHEALTH NET
CT3990545OtherAETNA
TINOtherNEHCA HMC/PPO
TINOtherFOCUS
TINOtherPIONEER