Provider Demographics
NPI:1962527275
Name:LOMBARDI, MARY HAYWOOD
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HAYWOOD
Last Name:LOMBARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 MONROE AVE
Mailing Address - Street 2:# 341
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5513
Mailing Address - Country:US
Mailing Address - Phone:509-460-1171
Mailing Address - Fax:
Practice Address - Street 1:3349 MONROE AVE
Practice Address - Street 2:# 341
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5513
Practice Address - Country:US
Practice Address - Phone:509-460-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040882208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHH79943Medicare UPIN
NHRE7103Medicare ID - Type Unspecified(LOCUM TENENS)