Provider Demographics
NPI:1063965267
Name:ZASTROW, LAUREN (PA)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:620 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2133
Mailing Address - Country:US
Mailing Address - Phone:302-338-9444
Mailing Address - Fax:302-994-9449
Practice Address - Street 1:620 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2133
Practice Address - Country:US
Practice Address - Phone:302-338-9444
Practice Address - Fax:302-994-9449
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0001078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE528477ZFKRMedicare PIN