Provider Demographics
NPI:1043491061
Name:LANCE, DAVID R (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:LANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 AKRON RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2518
Mailing Address - Country:US
Mailing Address - Phone:330-264-4899
Mailing Address - Fax:330-264-4874
Practice Address - Street 1:1900 AKRON RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2518
Practice Address - Country:US
Practice Address - Phone:330-264-4899
Practice Address - Fax:330-264-4874
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003501L207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0519111Medicaid
OH9343931Medicare PIN
OHC02525Medicare UPIN