Basic Information
| Provider Information | |||||||||
| NPI: | 1962405753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANINGHAM | ||||||||
| FirstName: | FRED | ||||||||
| MiddleName: | HAGEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 725 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 725 WELCH RD | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943041601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504978000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | G75723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 29598 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | G75723 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 009975820 | 05 | AL | MEDICAID | 00G75723 | 05 | CA | MEDICAID | 0089692 | 05 | MT | MEDICAID | 104677750 | 05 | MI | MEDICAID | 7613057 | 05 | NC | MEDICAID | 143636001 | 05 | AR | MEDICAID | 205329717 | 05 | MO | MEDICAID | 422400000 | 05 | ME | MEDICAID | 00124209 | 05 | MS | MEDICAID | 0547182 | 05 | IA | MEDICAID | 200347310A | 05 | KS | MEDICAID | 218597956A | 05 | GA | MEDICAID | 100249677-00 | 05 | NE | MEDICAID | 1110990 | 05 | LA | MEDICAID | 3863255 | 05 | TN | MEDICAID | 64044696 | 05 | KY | MEDICAID | 0030911 | 05 | NJ | MEDICAID | 200354520A | 05 | IN | MEDICAID |