Provider Demographics
NPI:1174623086
Name:SULLENBERGER, LANCE EUGENE (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:EUGENE
Last Name:SULLENBERGER
Suffix:
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 1:7 SOUTHWOODS BLVD
Mailing Address - Street 2:CAPITAL CARDIOLOGY ASSOCIATES, PC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2526
Mailing Address - Country:US
Mailing Address - Phone:518-292-6000
Mailing Address - Fax:518-292-6050
Practice Address - Street 1:7 SOUTHWOODS BLVD
Practice Address - Street 2:CAPITAL CARDIOLOGY ASSOCIATES, PC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2526
Practice Address - Country:US
Practice Address - Phone:518-292-6000
Practice Address - Fax:518-292-6050
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058708207RC0000X
NY247198207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015882Medicaid
MA2156164Medicaid
NYP00679142OtherMEDICARE, RAILROAD
NY02961168Medicaid
NYRB7493Medicare PIN