Provider Demographics
NPI:1710088299
Name:LASNER, LANCE ALAN (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:ALAN
Last Name:LASNER
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 1:6211 CENTREVILLE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121
Mailing Address - Country:US
Mailing Address - Phone:703-263-3393
Mailing Address - Fax:703-263-2606
Practice Address - Street 1:6211 CENTREVILLE RD
Practice Address - Street 2:STE 500
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121
Practice Address - Country:US
Practice Address - Phone:703-263-3393
Practice Address - Fax:703-263-2606
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055991207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710088299Medicaid
VA001014Medicare ID - Type Unspecified
VA190000757Medicare PIN