Basic Information
| Provider Information | |||||||||
| NPI: | 1093711723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALMAGE | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 W CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912200 | ||||||||
| FaxNumber: | 4194793297 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 W CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912200 | ||||||||
| FaxNumber: | 4194793297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35027676 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000064947 | 01 | OH | ANTHEM MEDICAID | OTHER | 142085 | 01 | OH | CARE CHOICE | OTHER | 6805 | 01 | MI | HPM | OTHER | OC07143 | 01 | OH | NATIONWIDE | OTHER | 0246559 | 05 | OH | MEDICAID | 4101220 | 01 | OH | AETNA | OTHER | 00099 | 01 | OH | PARAMOUNT | OTHER | 344428256097 | 01 | OH | CARESOURCES | OTHER | 4118789 | 05 | MI | MEDICAID | 000000064947 | 01 | OH | ANTHEM COMMERICAL | OTHER |