Provider Demographics
NPI:1932159910
Name:LANDRUM, ORLANDO (MD)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:LANDRUM
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 1:242 WATERFALL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-3646
Mailing Address - Country:US
Mailing Address - Phone:574-404-7246
Mailing Address - Fax:
Practice Address - Street 1:242 WATERFALL DR
Practice Address - Street 2:SUITE B
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-3646
Practice Address - Country:US
Practice Address - Phone:574-404-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95391207LP2900X
IN01068387A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201024800Medicaid
IN000000070184OtherANTHEM
INP00954967OtherRR MEDICARE
IN000000070184OtherANTHEM
INP00954967OtherRR MEDICARE