Basic Information
| Provider Information | |||||||||
| NPI: | 1710999198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOMBARD | ||||||||
| FirstName: | TESS | ||||||||
| MiddleName: | KRYSPIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 PHOENIX AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037568021 | ||||||||
| FaxNumber: | 2035963085 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 PHOENIX AVE | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067021418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037568021 | ||||||||
| FaxNumber: | 2035735832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 01/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 035945 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | TIN | 01 | NORTHEAST HEALTH DIRECT | OTHER | P00220769 | 01 | CT | RAILROAD MEDICARE | OTHER | P340749 | 01 | CT | OXFORD HEALTH PLANS | OTHER | TIN | 01 | FOCUS | OTHER | TIN | 01 | NATIONAL PROVIDER NETWORK | OTHER | 9037810 | 01 | CT | CIGNA | OTHER | TIN | 01 | PIONEER | OTHER | TIN | 01 | GREAT WEST | OTHER | TIN | 01 | FIRST HEALTH/ CCN | OTHER | TIN | 01 | MULTIPLAN | OTHER | 5695R1 | 01 | CT | EMPIRE BC/BS | OTHER | TIN | 01 | POMCO | OTHER | 010035945CT03 | 01 | CT | ANTHEM BC/BS | OTHER | 035945 | 01 | CT | CONNECTICARE | OTHER | 2V5273 | 01 | CT | HEALTH NET | OTHER | 3990545 | 01 | CT | AETNA | OTHER | TIN | 01 | NEHCA HMC/PPO | OTHER |