Individual
CODY TYLER LANCELLOTTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
1525 GREENSPRING VALLEY RD, STEVENSON, MD 21153-0641
(717) 825-6756
Mailing address
2178 HAIN RD, NEW FREEDOM, PA 17349-9268
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
A01097
MD
Other
Enumeration date
07/01/2022
Last updated
07/01/2022
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