Provider Demographics
NPI:1326606450
Name:LASTIG, MICHAEL M (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:LASTIG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WELTON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1336
Mailing Address - Country:US
Mailing Address - Phone:301-777-7900
Mailing Address - Fax:301-724-5590
Practice Address - Street 1:100 WELTON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1336
Practice Address - Country:US
Practice Address - Phone:301-777-7900
Practice Address - Fax:301-724-5590
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant