Provider Demographics
NPI:1376604496
Name:LANTER, TRACIE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:LEE
Last Name:LANTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1515 CHAIN BRIDGE RD
Mailing Address - Street 2:#312
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4451
Mailing Address - Country:US
Mailing Address - Phone:703-356-0600
Mailing Address - Fax:703-821-3465
Practice Address - Street 1:5530 WISCONSIN AVE STE 1445
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4302
Practice Address - Country:US
Practice Address - Phone:301-634-1345
Practice Address - Fax:240-330-4275
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VAVA010152759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA786134Medicare ID - Type Unspecified
VAG12340Medicare UPIN