Provider Demographics
NPI:1063518371
Name:LASSALETTA, MARGARITA (MD)
Entity type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:
Last Name:LASSALETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 WADSWORTH RD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8330
Mailing Address - Country:US
Mailing Address - Phone:330-336-5046
Mailing Address - Fax:330-336-5052
Practice Address - Street 1:185 WADSWORTH RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8330
Practice Address - Country:US
Practice Address - Phone:330-336-5046
Practice Address - Fax:330-336-5052
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-067706174400000X, 207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000309393OtherABCBS
OH2045085Medicaid
OH590852OtherATENA
G73569Medicare UPIN
OHLA0849709Medicare PIN
OH590852OtherATENA