Provider Demographics
NPI:1942386164
Name:LOMBARDO, MARK ANTHONY (DPM)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 BLACKWOOD AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4519
Mailing Address - Country:US
Mailing Address - Phone:407-578-9922
Mailing Address - Fax:407-578-9944
Practice Address - Street 1:1151 BLACKWOOD AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4519
Practice Address - Country:US
Practice Address - Phone:407-578-9922
Practice Address - Fax:407-578-9944
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02266213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
257432OtherCOVENTRY
FL390114900Medicaid
593642019OtherOUR TAX ID
001341964OtherHIGHMARK
115560OtherBCBS VIRTUAL OFFICE
441365OtherAMERIHEALTH
467623OtherCIGNA
65291OtherBCBS
10178101OtherCITRUS CARE
206983OtherAMERIGROUP
4472107OtherAETNA PPO
9653866OtherGHI
002054967OtherAPWU
P122459OtherPREFERRED ADMIN
P2637219OtherOXFORD
21763OtherHUMANA CHOICE CARE
480034764OtherPALMETTO
660814OtherCIGNA
2812186OtherAETNA HMO
65291BOtherMEDICARE
8990527OtherINDEP HEALTH ASSOC
9737791OtherGHI
185216321768OtherHUMANA EPO
185216321768OtherHUMANA EPO
593642019OtherOUR TAX ID