Provider Demographics
NPI:1093711723
Name:TALMAGE, LANCE A (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:A
Last Name:TALMAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3846
Mailing Address - Country:US
Mailing Address - Phone:419-291-2200
Mailing Address - Fax:419-479-3297
Practice Address - Street 1:2150 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3846
Practice Address - Country:US
Practice Address - Phone:419-291-2200
Practice Address - Fax:419-479-3297
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35027676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000064947OtherANTHEM MEDICAID
OH142085OtherCARE CHOICE
MI6805OtherHPM
OHOC07143OtherNATIONWIDE
OH0246559Medicaid
OH4101220OtherAETNA
OH00099OtherPARAMOUNT
OH344428256097OtherCARESOURCES
MI4118789Medicaid
OH000000064947OtherANTHEM COMMERICAL
OH000000064947OtherANTHEM COMMERICAL
MI6805OtherHPM