Provider Demographics
NPI:1790746139
Name:LANHAM, JOHN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOUIS
Last Name:LANHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:912 E HIGH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4866
Mailing Address - Country:US
Mailing Address - Phone:434-293-9797
Mailing Address - Fax:434-293-3379
Practice Address - Street 1:912 E HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4866
Practice Address - Country:US
Practice Address - Phone:434-293-9797
Practice Address - Fax:434-293-3379
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080011326OtherMEDICARE RAILROAD
VA5630193Medicaid
VA5630193Medicaid
VA080011326OtherMEDICARE RAILROAD