Provider Demographics
NPI:1821247917
Name:LANDER, LORI ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:LANDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 NORTHWOODS CT NE
Mailing Address - Street 2:APT. 4
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4593
Mailing Address - Country:US
Mailing Address - Phone:330-565-8386
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A40
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1960
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-6928225100000X
PAMA055871363A00000X
OH50.004189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118900Medicaid
OH366676Medicare Oscar/Certification