Provider Demographics
NPI:1598707762
Name:LASTOMIRSKY, DAVID GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GERARD
Last Name:LASTOMIRSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 BEACH RD
Mailing Address - Street 2:STE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6668
Mailing Address - Country:US
Mailing Address - Phone:203-255-2340
Mailing Address - Fax:203-255-0619
Practice Address - Street 1:1261 POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6072
Practice Address - Country:US
Practice Address - Phone:203-255-2340
Practice Address - Fax:203-255-0619
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-03-19
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Provider Licenses
StateLicense IDTaxonomies
CT031968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF23356Medicare UPIN