Provider Demographics
NPI:1700888963
Name:LANNIK, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:LANNIK
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 1:5818 D HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3327
Mailing Address - Country:US
Mailing Address - Phone:757-215-1400
Mailing Address - Fax:757-215-1403
Practice Address - Street 1:5818 D HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3327
Practice Address - Country:US
Practice Address - Phone:757-215-1400
Practice Address - Fax:757-215-1403
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006445063Medicaid
VA016566O04Medicare PIN
VA200000074Medicare ID - Type Unspecified
VA006445063Medicaid