Provider Demographics
NPI:1578518106
Name:LUTOSTANSKA, IZABELA SABINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IZABELA
Middle Name:SABINA
Last Name:LUTOSTANSKA
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 1:6 NATHAN DR
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1339
Mailing Address - Country:US
Mailing Address - Phone:207-729-8306
Mailing Address - Fax:
Practice Address - Street 1:TOGUS ROAD
Practice Address - Street 2:TOGUS VA HOSPITAL
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203965Medicare ID - Type UnspecifiedPROVIDER NUMBER MEDICARE