Basic Information
| Provider Information | |||||||||
| NPI: | 1497914691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANCASTER | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | CHAU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 N SENATE BLVD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462021239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179630166 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | MD60365987 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | M-12440 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | S-7764 | AK | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 01082089A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | MD60365987 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | S-7764 | AK | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | M-12440 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 01082089A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1613173 | 05 | AK | MEDICAID | 315283 | 01 | WA | LNI PROVIDER ID | OTHER | 315284 | 01 | WA | LNI PROVIDER ID | OTHER | 315300 | 01 | WA | LNI PROVIDER ID | OTHER | 2030507 | 05 | WA | MEDICAID | 1497914691 | 05 | ID | MEDICAID |