Provider Demographics
NPI:1063412955
Name:LASORDA, DAVID M (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:LASORDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-5822
Mailing Address - Fax:412-359-6620
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-359-5822
Practice Address - Fax:412-359-6620
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005325L207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0086892000Medicaid
PA0012080690005Medicaid
OH2444117Medicaid
OH2444117Medicaid
PAP00069207Medicare PIN
PA0012080690005Medicaid