Basic Information
| Provider Information | |||||||||
| NPI: | 1376604496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANTER | ||||||||
| FirstName: | TRACIE | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 CHAIN BRIDGE RD | ||||||||
| Address2: | #312 | ||||||||
| City: | MCLEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221014451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033560600 | ||||||||
| FaxNumber: | 7038213465 | ||||||||
| Practice Location | |||||||||
| Address1: | 5530 WISCONSIN AVE STE 1445 | ||||||||
| Address2: | |||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208154302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016341345 | ||||||||
| FaxNumber: | 2403304275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 02/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | VA010152759 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.