Provider Demographics
NPI:1124012455
Name:HASARA, LAWRENCE CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:CHRISTOPHER
Last Name:HASARA
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 1:2225 59TH ST W
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7017
Mailing Address - Country:US
Mailing Address - Phone:941-761-8955
Mailing Address - Fax:941-761-8975
Practice Address - Street 1:2225 59TH ST W
Practice Address - Street 2:SUITE D
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7017
Practice Address - Country:US
Practice Address - Phone:941-761-8955
Practice Address - Fax:941-761-8975
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53019207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201145979OtherTAX ID
FL048434200Medicaid
FL05878OtherBCBS
FLP00142313OtherMEDICARE RR
FLP00142313OtherMEDICARE RR
FLD51444Medicare UPIN