MEDICARE: DAVID E LANNIK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101035498	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700888963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E LANNIK MD

Provider Business Mailing Address
First Line	:	5818 D HARBOUR VIEW BLVD
Second Line	:	SUITE 150
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3327
Country	:	US
Telephone Number	:	757-215-1400
Fax Number	:	757-215-1403

Provider Business Practice Location Address
First Line	:	5818 D HARBOUR VIEW BLVD
Second Line	:	SUITE 150
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3327
Country	:	US
Telephone Number	:	757-215-1400
Fax Number	:	757-215-1403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/25/2011

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