Provider Demographics
NPI:1891791091
Name:LOMBARDO, THOMAS RANDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RANDOLPH
Last Name:LOMBARDO
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 1:755 N 11TH ST STE P2200
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1513
Mailing Address - Country:US
Mailing Address - Phone:409-892-1192
Mailing Address - Fax:409-924-9012
Practice Address - Street 1:755 N 11TH ST STE P2200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1513
Practice Address - Country:US
Practice Address - Phone:409-892-1192
Practice Address - Fax:409-924-9012
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9748207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122877701Medicaid
TX060049471OtherRAILROAD MEDICARE
TX060049471OtherRAILROAD MEDICARE
TXB24455Medicare UPIN