Provider Demographics
NPI:1083670210
Name:PHYSICIAN &SURGEON, P.C.
Entity Type:Organization
Organization Name:PHYSICIAN &SURGEON, P.C.
Other - Org Name:JOHN A. LANZALOTTI, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LANZALOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-253-2450
Mailing Address - Street 1:136 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3374
Mailing Address - Country:US
Mailing Address - Phone:757-253-2450
Mailing Address - Fax:757-253-2607
Practice Address - Street 1:136 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3374
Practice Address - Country:US
Practice Address - Phone:757-253-2450
Practice Address - Fax:757-253-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA34584261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA20000048Medicare ID - Type Unspecified
VAB08367Medicare UPIN