Basic Information
| Provider Information | |||||||||
| NPI: | 1487818977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANNUTTI | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | DELANEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DELANEY | ||||||||
| OtherFirstName: | ELEANOR | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 400 W 7TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405663300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9507 HOSPITAL AVE. | ||||||||
| Address2: | |||||||||
| City: | NASSAWADOX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574148000 | ||||||||
| FaxNumber: | 7574148618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2008 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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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 | 208M00000X | 0102202825 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0102202825 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1487818977 | 05 | VA | MEDICAID |