Provider Demographics
NPI:1588921506
Name:PASTERNAK, LEWIS REUVEN (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:REUVEN
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MAYHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2235
Mailing Address - Country:US
Mailing Address - Phone:703-774-6147
Mailing Address - Fax:888-774-6147
Practice Address - Street 1:1400 MAYHURST BLVD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2235
Practice Address - Country:US
Practice Address - Phone:703-774-6147
Practice Address - Fax:888-774-6147
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247047207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101247047OtherMEDICAL LICENSE
MDD26887OtherMEDICAL LICENSE
MDD72027Medicare UPIN