Provider Demographics
NPI:1023005154
Name:LACKNER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LACKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PENN CENTER BLVD
Mailing Address - Street 2:STE 555
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 HECKEL RD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1651
Practice Address - Country:US
Practice Address - Phone:412-777-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036163E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA141438OtherHIGHMARK
B39135Medicare UPIN
141438Medicare ID - Type Unspecified