Provider Demographics
NPI:1265439822
Name:GOMBA, LORRAINE A (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:A
Last Name:GOMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9120
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02027-9120
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154246208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
772904OtherTUFTS TOTAL HEALTH PLAN
J18280OtherHMO BLUE/BLUE CHOICE
3172341OtherMASS HEALTH
772904OtherTUFTS BENEFIT ADMIN
AA20257OtherFIRST SENIORITY
AA20257OtherHARVARD PILGRIM POS
772904OtherTUFTS
AA20257OtherHARVARD/PILGRIM
J18280OtherBLUE SHIELD INDEMNITY
J18280OtherBS-BLUE CARE ELECT
7336967OtherCIGNA HEALTH CARE
AA20257OtherHARVARD PILGRIM PPO
0013248OtherNEIGHBORHOOD HEALTH PLAN
7336967OtherHEALTHSOURCE-MA
57553OtherCHILDREN'S MEDICAL SECURI
772904OtherTUFTS COMMONWEALTH
772904OtherTUFTS TOTAL HEALTH PLAN
J18280OtherBS-BLUE CARE ELECT