Provider Demographics
NPI:1629289558
Name:SALYARD, LANN (MD)
Entity Type:Individual
Prefix:
First Name:LANN
Middle Name:
Last Name:SALYARD
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 1:245 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3520
Mailing Address - Country:US
Mailing Address - Phone:215-829-5267
Mailing Address - Fax:215-829-8596
Practice Address - Street 1:245 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3520
Practice Address - Country:US
Practice Address - Phone:215-829-5267
Practice Address - Fax:215-829-8596
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033785E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001412311 0003OtherPROVIDER NUMBER
PA0684184Medicare ID - Type UnspecifiedMA PROVIDER NUMBER