Provider Demographics
NPI:1962405753
Name:LANINGHAM, FRED HAGEN III (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:HAGEN
Last Name:LANINGHAM
Suffix:III
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 1:725 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8000
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN295982085P0229X, 2085R0202X
CAG757232085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G75723Medicaid
LA1110990Medicaid
IN200354520AMedicaid
NC7613057Medicaid
NE100249677-00Medicaid
KS200347310AMedicaid
NJ0030911Medicaid
MI104677750Medicaid
AR143636001Medicaid
KY64044696Medicaid
MT0089692Medicaid
AL009975820Medicaid
GA218597956AMedicaid
ME422400000Medicaid
MS00124209Medicaid
MO205329717Medicaid
TN3863255Medicaid
IA0547182Medicaid
IA0547182Medicaid
GA218597956AMedicaid
NJ0030911Medicaid