MEDICARE: LORI ANN LANDER PA-C

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	225100000X	Physical Therapist	PT-6928	OH
2	363A00000X	Physician Assistant	MA055871	PA
3	363A00000X	Physician Assistant	50.004189	OH

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	:	1821247917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANN LANDER PA-C

Provider Business Mailing Address
First Line	:	3880 NORTHWOODS CT NE
Second Line	:	APT. 4
City	:	WARREN
State	:	OH
Zip	:	44483-4593
Country	:	US
Telephone Number	:	330-565-8386
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # A40
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1960
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

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

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	06/19/2023

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