Provider Demographics
NPI:1184606766
Name:LANIER, ANTHONY R (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:LANIER
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 1:1150 NILES CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446
Mailing Address - Country:US
Mailing Address - Phone:330-652-1759
Mailing Address - Fax:330-652-2719
Practice Address - Street 1:1150 NILES CORTLAND RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446
Practice Address - Country:US
Practice Address - Phone:330-651-1759
Practice Address - Fax:330-652-2719
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2040866Medicaid
OH2040866Medicaid
OHLA0828552Medicare PIN
LA0828552Medicare ID - Type Unspecified
G55224Medicare UPIN