Provider Demographics
NPI:1790763480
Name:LANCASTER, LARYENTH D (MD)
Entity Type:Individual
Prefix:DR
First Name:LARYENTH
Middle Name:D
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2138
Mailing Address - Fax:520-838-2260
Practice Address - Street 1:1714 W ANKLAM RD STE 104
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2690
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ17217207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266652Medicaid
D37161Medicare UPIN
AZ266652Medicaid
AZZ111183Medicare PIN
AZZ20465Medicare PIN
AZZ20467Medicare PIN