Provider Demographics
NPI:1053598755
Name:MARIO A LAMMOGLIA MD PA
Entity type:Organization
Organization Name:MARIO A LAMMOGLIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-764-1474
Mailing Address - Street 1:1721 BIRMINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4082
Mailing Address - Country:US
Mailing Address - Phone:979-764-1474
Mailing Address - Fax:979-764-9249
Practice Address - Street 1:1721 BIRMINGHAM DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4082
Practice Address - Country:US
Practice Address - Phone:979-764-1474
Practice Address - Fax:979-764-9249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1859207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199331301Medicaid
TX199331301Medicaid
TXG36657Medicare UPIN