Provider Demographics
NPI:1801822283
Name:LANZA, BENJAMIN A (DPM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:LANZA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3536
Mailing Address - Country:US
Mailing Address - Phone:803-779-5005
Mailing Address - Fax:803-252-1720
Practice Address - Street 1:1900 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3536
Practice Address - Country:US
Practice Address - Phone:803-779-5005
Practice Address - Fax:803-252-1720
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0076213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT236873353Medicare UPIN
SCT236875953Medicare UPIN
SCT23687Medicare UPIN
SCT236876014Medicare PIN
SCAA45973354Medicare UPIN
SCAA45973357Medicare UPIN
SCT236876719Medicare UPIN