Provider Demographics
NPI:1922052588
Name:LANCIANO, RALPH C (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:C
Last Name:LANCIANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3374
Mailing Address - Country:US
Mailing Address - Phone:856-665-5533
Mailing Address - Fax:856-665-5055
Practice Address - Street 1:7703 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3374
Practice Address - Country:US
Practice Address - Phone:856-665-5533
Practice Address - Fax:856-665-5055
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOS002255L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ041850Medicare ID - Type Unspecified
NJC52423Medicare UPIN