1679555452 NPI number — LAWRENCE P. SHOMBERT MD

Table of content: (NPI 1477890689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679555452 NPI number — LAWRENCE P. SHOMBERT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOMBERT
Provider First Name:
LAWRENCE
Provider Middle Name:
P.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1679555452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12500 WILLOWBROOK RD DEPT OF
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-6393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-1400
Provider Business Mailing Address Fax Number:
240-964-1490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12500 WILLOWBROOK RD DEPT OF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-6393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-1400
Provider Business Practice Location Address Fax Number:
240-964-1490
Provider Enumeration Date:
11/16/2005

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: 2085R0001X , with the licence number:  042.0016222 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: D43914 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810019575 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6882-0001 . This is a "CAREFIRST BCBS- DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52981008 . This is a "CARE FIRST BCBS PROV. #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00894865 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BCBS DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00441743 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00458397 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 213391100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5273 . This is a "ELDER HEALTH PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 529810-09 . This is a "BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 038445300 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com