Basic Information
| Provider Information | |||||||||
| NPI: | 1134156623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYO | ||||||||
| FirstName: | LORNA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 S. 6TH AVE 4-116E | ||||||||
| Address2: | SOUTHERN ARIZONA VA HEALTH CARE SYSTEM | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207921450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 S. 6TH AVE 4-116E | ||||||||
| Address2: | SOUTHERN ARIZONA VA HEALTH CARE SYSTEM | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207921450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 042-0010503 | VT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 12268 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 2084P0800X | 12268 | NH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 042-0010503 | VT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1012680 | 05 | VT | MEDICAID |