1376587576 NPI number — VINCENT G LOBO DO

Table of content: VINCENT G LOBO DO (NPI 1376587576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376587576 NPI number — VINCENT G LOBO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOBO
Provider First Name:
VINCENT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376587576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHANY BEACH
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19930-1036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-242-6352
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 SHAW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19952-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-398-8704
Provider Business Practice Location Address Fax Number:
302-398-8818
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C2-0000334 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4363549 . This is a "AETNA PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 66481 . This is a "BCBSDE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 3870195 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 3778895 . This is a "AETNA HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2369122000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P00225770 . This is a "PALMETTO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 202298856 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 202298856 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000035903 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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