Provider Demographics
NPI:1851368732
Name:JANDER, LUCIA (MD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:JANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:
Other - Last Name:COLUMBYOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:217 N AURORA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-273-2811
Mailing Address - Fax:607-273-1170
Practice Address - Street 1:217 N AURORA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-273-2811
Practice Address - Fax:607-273-1170
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02367595Medicaid
H15201Medicare UPIN
NY02367595Medicaid