Provider Demographics
NPI:1467477281
Name:LASAKI, ABIOSE O (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIOSE
Middle Name:O
Last Name:LASAKI
Suffix:
Gender:F
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:PO BOX 11117
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5019
Mailing Address - Country:US
Mailing Address - Phone:434-228-3620
Mailing Address - Fax:
Practice Address - Street 1:130 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4070
Practice Address - Country:US
Practice Address - Phone:434-791-2273
Practice Address - Fax:434-791-2824
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600005207Q00000X
VA0101053209207Q00000X
TXP4668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080008121Medicare PIN
VA1248110001Medicare NSC