Provider Demographics
NPI:1194778753
Name:TRAYNHAM, LACIANNA M (MD)
Entity type:Individual
Prefix:
First Name:LACIANNA
Middle Name:M
Last Name:TRAYNHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6482
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:ACUTE CARE PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-6515
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1900705OtherAETNA HMO
7699587OtherAETNA PPO
MD415304900Medicaid
S3990050OtherCAREFIRST
93832401OtherCAREFIRST
213993OtherJOHNS HOPKINS USF, EHP AND PRIORITY PARTNERS
277005OtherKAISER PERMANENTE
277005OtherKAISER PERMANENTE
132254ZADNMedicare PIN
1900705OtherAETNA HMO
7699587OtherAETNA PPO