Provider Demographics
NPI:1962483230
Name:LANSING, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:LANSING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 GREENE TREE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-484-5686
Mailing Address - Fax:410-484-6472
Practice Address - Street 1:1838 GREENE TREE ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-484-5686
Practice Address - Fax:410-484-6472
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD42827207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD757411800Medicaid
MDKP24JAMedicare ID - Type Unspecified
MD757411800Medicaid