Provider Demographics
NPI:1366467953
Name:LANNA, OLIVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:LANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCILLE
Other - Middle Name:VINCENE
Other - Last Name:LANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:107 HALSTED DR
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1661
Mailing Address - Country:US
Mailing Address - Phone:781-987-3388
Mailing Address - Fax:781-740-0200
Practice Address - Street 1:350 LINCOLN ST STE 1102
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1578
Practice Address - Country:US
Practice Address - Phone:781-987-3388
Practice Address - Fax:781-740-0200
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89292207R00000X
RI6728207R00000X
MA56882208M00000X, 207R00000X
CT03530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT03530OtherCONNECTICUT MEDICAL LICENSE
RI20213-0OtherBCBS
RI0403778OtherUHC
MA110090092OOtherMASSHEALTH
MA6869724OtherCIGNA
56882OtherMASS MEDICAL LICENSE
MA5803533OtherAETNA
MA929481 02OtherNETWORK HEALTH
MAE56882OtherMASSACHUSETTS MEDICAL LICENSE
CAG89292OtherSTATE MEDICAL LICENSE
RIMD06728OtherRI MEDICAL LICENSE
MA1070059OtherHCVM
CT03530OtherCONNECTICUT MEDICAL LICENSE
RIE56641Medicare UPIN