Provider Demographics
NPI:1154388064
Name:LEMBO, NANCY ROSE (DO)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ROSE
Last Name:LEMBO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 TRAVELERS BLVD SUITE D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485
Mailing Address - Country:US
Mailing Address - Phone:843-569-5421
Mailing Address - Fax:843-569-5973
Practice Address - Street 1:763 TRAVELERS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8796
Practice Address - Country:US
Practice Address - Phone:843-569-5421
Practice Address - Fax:843-569-5973
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9182081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009181Medicaid
SC400863Medicaid
SC009181Medicaid
SCG493817684Medicare UPIN