Provider Demographics
NPI:1083681720
Name:LASSITER, RICHARD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:LASSITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CONNER DRIVE
Mailing Address - Street 2:#101
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-942-8571
Mailing Address - Fax:919-942-6355
Practice Address - Street 1:120 CONNER DR
Practice Address - Street 2:#101 CHAPEL HILL OB GYN
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-942-8571
Practice Address - Fax:919-942-6355
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14710207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1284196003OtherUHC
NC51065OtherCIGNA
NC562142486OtherBEECHSTREET
NC8951065Medicaid
NC154775OtherWELLPATH
NC2437979OtherAETNA
NC51065OtherBCBS
NC26825OtherMEDCOST
NC51065OtherBCBS
NC26825OtherMEDCOST