Provider Demographics
NPI:1972712024
Name:MARK B. LONSTEIN, MD, PA
Entity type:Organization
Organization Name:MARK B. LONSTEIN, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAXA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-917-6500
Mailing Address - Street 1:2032 HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2334
Mailing Address - Country:US
Mailing Address - Phone:941-917-6500
Mailing Address - Fax:941-917-6504
Practice Address - Street 1:2032 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2334
Practice Address - Country:US
Practice Address - Phone:941-917-6500
Practice Address - Fax:941-917-6504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK B. LONSTEIN, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05960BMedicare ID - Type Unspecified