Provider Demographics
NPI:1205875523
Name:LAI, LO AN NHU (MD)
Entity type:Individual
Prefix:
First Name:LO AN
Middle Name:NHU
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:4924 CAMPBELL BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5908
Practice Address - Country:US
Practice Address - Phone:443-461-1997
Practice Address - Fax:443-461-1998
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60050001OtherDC BLUE CROSS
MD20047178OtherAMERIHEALTH MERCY HEALTH
MD406555700Medicaid
489PR160OtherMD MEDICARE
MD60059303OtherBLUE CROSS
MDI22056Medicare UPIN
MD161MK067Medicare ID - Type Unspecified
MD149840ZDDBMedicare PIN
MD149840YVZMedicare PIN
MD60050001OtherDC BLUE CROSS
MD406555700Medicaid