Provider Demographics
NPI:1386185395
Name:LATTANZI, STEVEN (CP, COA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:LATTANZI
Suffix:
Gender:M
Credentials:CP, COA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 BOX HILL CORPORATE CENTER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1204
Mailing Address - Country:US
Mailing Address - Phone:410-569-0606
Mailing Address - Fax:410-569-7477
Practice Address - Street 1:3435 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1204
Practice Address - Country:US
Practice Address - Phone:410-569-0606
Practice Address - Fax:410-569-7477
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPO000211224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist