Provider Demographics
NPI:1376715441
Name:LASCANO, CHARLES A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:LASCANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8400 NW 33RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1937
Mailing Address - Country:US
Mailing Address - Phone:844-665-4827
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 87TH AVE
Practice Address - Street 2:SUITE 101 AND 201
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2654
Practice Address - Country:US
Practice Address - Phone:305-718-9138
Practice Address - Fax:305-718-9191
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 103606207QS0010X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCS823ZMedicare PIN