Basic Information
| Provider Information | |||||||||
| NPI: | 1083893689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANTIN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | THERESE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HARMON LOOP RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | DEDEDO | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969296536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716333800 | ||||||||
| FaxNumber: | 6716333801 | ||||||||
| Practice Location | |||||||||
| Address1: | 755 MEMORIAL PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088652748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084546303 | ||||||||
| FaxNumber: | 9084542289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2007 | ||||||||
| LastUpdateDate: | 09/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M-1992 | GU | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A112424 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.