1912967076 NPI number — DR. C. WAYNE LANKFORD MD

Table of content: DR. C. WAYNE LANKFORD MD (NPI 1912967076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912967076 NPI number — DR. C. WAYNE LANKFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANKFORD
Provider First Name:
C.
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912967076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 758963
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-8963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-968-5700
Provider Business Mailing Address Fax Number:
804-217-7991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 TAYLOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-215-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  28058 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6889 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89-0239J , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50922 . This is a "BLUE CROSS BLUE SHIELD NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com