Basic Information
| Provider Information | |||||||||
| NPI: | 1760400063 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANZIERI | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | F. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24701 EUCLID AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441171714 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441700 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 05/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 35-053060 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 4392681 | 01 | OH | AETNA | OTHER | 0641238 | 05 | OH | MEDICAID | 0304914 | 01 | OH | BCMH | OTHER | P00364290 | 01 | OH | RAILROAD MEDICARE | OTHER | 156272 | 01 | NJ | NJ MEDICAID | OTHER | 000000217366 | 01 | OH | UNISON | OTHER | 1760400063 | 01 | MI | MI MEDICAID | OTHER | 369141 | 01 | OH | WELLCARE | OTHER | 734423 | 01 | OH | BUCKEYE | OTHER | 000000503582 | 01 | OH | ANTHEM | OTHER | 1012178750001 | 05 | PA | MEDICAID |