Provider Demographics
NPI:1083722359
Name:LUCILLE LANNA MD,LTD.
Entity Type:Organization
Organization Name:LUCILLE LANNA MD,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-921-6700
Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-921-6700
Mailing Address - Fax:401-921-6705
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-921-6700
Practice Address - Fax:888-422-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI122505198OtherTRICARE
RI6869724OtherCIGNA
RI0403778OtherUNITED HEALTH
RI20213-0OtherBCBS
RI400794OtherBLUE CHIP
RI400794OtherBLUE CHIP