Provider Demographics
NPI:1952358640
Name:LOMVARDIAS, STYLIANOS (MD)
Entity type:Individual
Prefix:
First Name:STYLIANOS
Middle Name:
Last Name:LOMVARDIAS
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 1:5465 FIELDSTON RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2501
Mailing Address - Country:US
Mailing Address - Phone:718-548-0443
Mailing Address - Fax:
Practice Address - Street 1:112 GAINSBOROUGH SQUARE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320
Practice Address - Country:US
Practice Address - Phone:757-547-0798
Practice Address - Fax:757-547-0145
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36598207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA17739Medicare UPIN