Provider Demographics
NPI:1437257250
Name:LANDVATER, LANCE ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ERIC
Last Name:LANDVATER
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 1:2800 BLUE RIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6477
Mailing Address - Country:US
Mailing Address - Phone:919-784-7110
Mailing Address - Fax:919-784-7111
Practice Address - Street 1:2800 BLUE RIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6477
Practice Address - Country:US
Practice Address - Phone:919-784-7111
Practice Address - Fax:919-784-7110
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31318208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890724Medicaid
208072Medicare ID - Type Unspecified
NC890724Medicaid