1366467953 NPI number — DR. OLIVIA LANNA M.D.

Table of content: DR. OLIVIA LANNA M.D. (NPI 1366467953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366467953 NPI number — DR. OLIVIA LANNA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANNA
Provider First Name:
OLIVIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANNA
Provider Other First Name:
LUCILLE
Provider Other Middle Name:
VINCENE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366467953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 HALSTED DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02043-1661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-987-3388
Provider Business Mailing Address Fax Number:
781-740-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 LINCOLN ST STE 1102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02043-1578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-987-3388
Provider Business Practice Location Address Fax Number:
781-740-0200
Provider Enumeration Date:
07/13/2006

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: 207R00000X , with the licence number:  89292 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 6728 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 56882 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 03530 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 56882 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03530 . This is a "CONNECTICUT MEDICAL LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 20213-0 . This is a "BCBS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0403778 . This is a "UHC" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 110090092O . This is a "MASSHEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6869724 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 56882 . This is a "MASS MEDICAL LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5803533 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 929481 02 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: E56882 . This is a "MASSACHUSETTS MEDICAL LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: G89292 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MD06728 . This is a "RI MEDICAL LICENSE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1070059 . This is a "HCVM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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