Provider Demographics
NPI:1083893689
Name:LANTIN, ANGELA THERESE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:THERESE
Last Name:LANTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HARMON LOOP RD
Mailing Address - Street 2:STE 105
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6536
Mailing Address - Country:US
Mailing Address - Phone:671-633-3800
Mailing Address - Fax:671-633-3801
Practice Address - Street 1:755 MEMORIAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-454-6303
Practice Address - Fax:908-454-2289
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1992207Q00000X
CAA112424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine