Provider Demographics
NPI:1699758763
Name:ROSTOCKI, LUKASZ A (MD)
Entity type:Individual
Prefix:DR
First Name:LUKASZ
Middle Name:A
Last Name:ROSTOCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 FAIRVIEW HEIGHTS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9308
Mailing Address - Country:US
Mailing Address - Phone:304-872-5381
Mailing Address - Fax:304-872-3989
Practice Address - Street 1:400 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9308
Practice Address - Country:US
Practice Address - Phone:304-872-5381
Practice Address - Fax:304-872-3989
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 053274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F98370Medicare UPIN
CA00A0532740Medicare ID - Type Unspecified