Provider Demographics
NPI:1205826807
Name:LANZO, DOMINICK ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:ALLAN
Last Name:LANZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:443-849-3838
Mailing Address - Fax:443-849-3842
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 606
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:443-849-3838
Practice Address - Fax:443-849-3842
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039790174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113611900Medicaid
MDE66440Medicare UPIN
MD113611900Medicaid