Basic Information
| Provider Information | |||||||||
| NPI: | 1194778753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAYNHAM | ||||||||
| FirstName: | LACIANNA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64916 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816482 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 MEDICAL PKWY | ||||||||
| Address2: | ACUTE CARE PAVILION | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 01/12/2009 | ||||||||
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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 | 207R00000X | 057693 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1900705 | 01 | AETNA HMO | OTHER | 7699587 | 01 | AETNA PPO | OTHER | 415304900 | 05 | MD | MEDICAID | BT8931621 | 01 | GA | DEA | OTHER | S3990050 | 01 | CAREFIRST | OTHER | 93832401 | 01 | CAREFIRST | OTHER | 213993 | 01 | JOHNS HOPKINS USF, EHP AND PRIORITY PARTNERS | OTHER | 277005 | 01 | KAISER PERMANENTE | OTHER |