Individual
GEORGE BERKLEY LANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1 MEDICAL CENTER DR, LEBANON, NH 03756-0001
(603) 650-6040
Mailing address
1 MEDICAL CENTER DR, LEBANON, NH 03756-0001
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0320000509
VT
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
15195
NH
208VP0014X
Interventional Pain Medicine Physician
15195
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020484753
FEDERAL TAX ID
—
01
—
100000500818
MVP HEALTHCARE
—
05
—
30229131
—
NH
01
—
AA212876
HARVARD PILGRIM
—
Enumeration date
04/03/2006
Last updated
09/09/2019
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