Healthcare Provider Details

I. General information

NPI: 1952358640
Provider Name (Legal Business Name): STYLIANOS LOMVARDIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 GAINSBOROUGH SQUARE SUITE 200
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

5465 FIELDSTON RD
RIVERDALE NY
10471-2501
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0798
  • Fax: 757-547-0145
Mailing address:
  • Phone: 718-548-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number36598
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: