MEDICARE: DR. DAVID NEUBAUER LOMBARD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TF0200X	Forensic Psychologist	20041481A	IN

General Provider Information

NPI Number	:	1891836417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID NEUBAUER LOMBARD PHD

Provider Business Mailing Address
First Line	:	3242 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2883
Country	:	US
Telephone Number	:	260-459-2900
Fax Number	:	260-459-2901

Provider Business Practice Location Address
First Line	:	3242 MALLARD COVE LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2883
Country	:	US
Telephone Number	:	260-459-2900
Fax Number	:	260-459-2901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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