Provider Demographics
NPI:1568409415
Name:FANANAPAZIR, LAMEH (MD)
Entity Type:Individual
Prefix:
First Name:LAMEH
Middle Name:
Last Name:FANANAPAZIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 WILLOWBROOK ROAD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6567
Mailing Address - Country:US
Mailing Address - Phone:301-777-1997
Mailing Address - Fax:301-784-1759
Practice Address - Street 1:12502 WILLOWBROOK ROAD
Practice Address - Street 2:SUITE 420
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6567
Practice Address - Country:US
Practice Address - Phone:301-777-1997
Practice Address - Fax:301-784-1759
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039832174400000X, 207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003478Medicaid
MD408906500Medicaid
MDI43227Medicare UPIN
WV3810003478Medicaid