Provider Demographics
NPI:1912928318
Name:ANTOMMARCHI, LORIANN (MD)
Entity Type:Individual
Prefix:MS
First Name:LORIANN
Middle Name:
Last Name:ANTOMMARCHI
Suffix:
Gender:F
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:LA QUINTA CALLE 5 J 14
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-829-4476
Mailing Address - Fax:787-829-2569
Practice Address - Street 1:20 CALLE RIUS RIVERA
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2337
Practice Address - Country:US
Practice Address - Phone:787-829-4476
Practice Address - Fax:787-829-2569
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14588208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1-19251Medicare UPIN