Provider Demographics
NPI:1083659007
Name:LASATER, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:LASATER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4000 COLISEUM DR
Mailing Address - Street 2:STE 300
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5906
Mailing Address - Country:US
Mailing Address - Phone:757-452-3441
Mailing Address - Fax:757-224-1799
Practice Address - Street 1:4000 COLISEUM DR
Practice Address - Street 2:STE 300
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5906
Practice Address - Country:US
Practice Address - Phone:757-452-3441
Practice Address - Fax:757-224-1799
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC31041208800000X
VA0101040054208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02298OtherBCBS
NC8902298Medicaid
C85068Medicare UPIN
NC230164Medicare ID - Type Unspecified