MEDICARE: SPARTANBURG ALLERGY AND ASTHMA P A

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	207KA0200X	Allergy Physician	17136	SC

General Provider Information

NPI Number	:	1073857397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARTANBURG ALLERGY AND ASTHMA P A

Provider Business Mailing Address
First Line	:	1092 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2247
Country	:	US
Telephone Number	:	864-542-8900
Fax Number	:	864-542-2954

Provider Business Practice Location Address
First Line	:	1092 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2247
Country	:	US
Telephone Number	:	864-542-8900
Fax Number	:	864-542-2954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANGELINA JOANN LOMBARDI
Credential	:	MD
Telephone Number	:	864-542-8900

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	12/10/2012

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