Provider Demographics
NPI:1992756845
Name:UNIVERSITY PSYCHIATRIC ASSOCIATES P.A.
Entity type:Organization
Organization Name:UNIVERSITY PSYCHIATRIC ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-549-8797
Mailing Address - Street 1:8320 UNIVERSITY EXEC PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1338
Mailing Address - Country:US
Mailing Address - Phone:704-549-8797
Mailing Address - Fax:704-549-1479
Practice Address - Street 1:8320 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1338
Practice Address - Country:US
Practice Address - Phone:704-549-8797
Practice Address - Fax:704-549-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC892790HMedicaid
NC2313254Medicare PIN
NC892790HMedicaid