1457539694 NPI number — MR. SALVATORE GIALLOMBARDO III IDC

Table of content: MR. SALVATORE GIALLOMBARDO III IDC (NPI 1457539694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457539694 NPI number — MR. SALVATORE GIALLOMBARDO III IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIALLOMBARDO
Provider First Name:
SALVATORE
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIALLOMBARDO
Provider Other First Name:
SAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
IDC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457539694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5256 CHIPPING LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23455-6801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-507-9403
Provider Business Mailing Address Fax Number:
757-961-7240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
581 A ST BLDG 312
Provider Second Line Business Practice Location Address:
MSFSC
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23511-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-443-3194
Provider Business Practice Location Address Fax Number:
757-443-2364
Provider Enumeration Date:
02/08/2008

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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