Provider Demographics
NPI:1518153360
Name:ALAN R LUSTIG MD PA
Entity Type:Organization
Organization Name:ALAN R LUSTIG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUSTIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-821-2388
Mailing Address - Street 1:1201 5TH AVE N
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1400
Mailing Address - Country:US
Mailing Address - Phone:727-821-2388
Mailing Address - Fax:727-821-6887
Practice Address - Street 1:1201 5TH AVE N
Practice Address - Street 2:SUITE 302
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1400
Practice Address - Country:US
Practice Address - Phone:727-821-2388
Practice Address - Fax:727-821-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5073Medicare PIN