Provider Demographics
NPI:1457539694
Name:GIALLOMBARDO, SALVATORE III (IDC)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:GIALLOMBARDO
Suffix:III
Gender:M
Credentials:IDC
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:GIALLOMBARDO
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:5256 CHIPPING LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6801
Mailing Address - Country:US
Mailing Address - Phone:904-507-9403
Mailing Address - Fax:757-961-7240
Practice Address - Street 1:581 A ST BLDG 312
Practice Address - Street 2:MSFSC
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-4004
Practice Address - Country:US
Practice Address - Phone:757-443-3194
Practice Address - Fax:757-443-2364
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman