MEDICARE: MELVYN A. LOBO MD

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	207Q00000X	Family Medicine Physician	223096-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070109000001	OTHER	NY	FIDELIS
2	000499349004	OTHER	NY	BSNENY
3	5780B1	OTHER	NY	EMPIRE BC
4	7692511	OTHER	NY	AETNA
5	114977	OTHER	NY	GHI/HMO
6	10059187	OTHER	NY	CDPHP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	200104	OTHER	NY	SENIOR WHOLE HEALTH
9	4151243	OTHER	NY	MVP
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447226006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVYN A. LOBO MD

Provider Business Mailing Address
First Line	:	1960 POINTE WEST DR
Second Line	:	SUITES 101 & 102
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-564-7828
Fax Number	:	772-564-6107

Provider Business Practice Location Address
First Line	:	1960 POINTE WEST DR
Second Line	:	SUITES 101 & 102
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-564-7828
Fax Number	:	772-564-6107

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	09/21/2012

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