Healthcare Provider Details

I. General information

NPI: 1538295415
Provider Name (Legal Business Name): RICHARD ALLEN LANHAM JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 CHAPEL HILL RD
SILVER SPRING MD
20906-1117
US

IV. Provider business mailing address

1109 SPRING ST SUITE 604
SILVER SPRING MD
20910-4002
US

V. Phone/Fax

Practice location:
  • Phone: 301-598-3960
  • Fax:
Mailing address:
  • Phone: 301-587-2818
  • Fax: 301-587-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number03098
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: