Provider Demographics
NPI:1801978804
Name:JORANDBY, LANTIE ELISABETH (MD)
Entity type:Individual
Prefix:
First Name:LANTIE
Middle Name:ELISABETH
Last Name:JORANDBY
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 1:10701 PARKRIDGE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4359
Mailing Address - Country:US
Mailing Address - Phone:703-880-4000
Mailing Address - Fax:
Practice Address - Street 1:10701 PARKRIDGE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4359
Practice Address - Country:US
Practice Address - Phone:703-880-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2641362084N0400X
FLME910542084N0400X
VA01012593022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AJ618YMedicare PIN