Provider Demographics
NPI:1497914691
Name:LANCASTER, SAMANTHA CHAU (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:CHAU
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-963-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603659872085N0700X, 2085R0202X
IDM-124402085N0700X, 2085R0202X
AKS-77642085N0700X, 2085R0202X
IN01082089A2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1613173Medicaid
WA315283OtherLNI PROVIDER ID
WA315284OtherLNI PROVIDER ID
WA315300OtherLNI PROVIDER ID
WA2030507Medicaid
ID1497914691Medicaid
ID1497914691Medicaid
WA315300OtherLNI PROVIDER ID
WA315283OtherLNI PROVIDER ID
WAG8923439Medicare PIN
WAP01277149Medicare PIN
WAG8923382Medicare PIN
ID20005375Medicare PIN
WAG8923591Medicare PIN