Provider Demographics
NPI:1154580298
Name:LAMEH FANANAPAZIR MD PA
Entity type:Organization
Organization Name:LAMEH FANANAPAZIR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:FANANAPAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-1997
Mailing Address - Street 1:12502 WILLOWBROOK RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6567
Mailing Address - Country:US
Mailing Address - Phone:301-777-1997
Mailing Address - Fax:301-784-1759
Practice Address - Street 1:12502 WILLOWBROOK ROAD
Practice Address - Street 2:SUITE 420
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6567
Practice Address - Country:US
Practice Address - Phone:301-777-1997
Practice Address - Fax:301-784-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015493Medicaid
MD408906500Medicaid
WV3810015493Medicaid
MD642PMedicare PIN