Provider Demographics
NPI:1609283936
Name:OSETINSKY, LARA MARIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:MARIEL
Last Name:OSETINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:L. MARIEL
Other - Middle Name:
Other - Last Name:OSETINSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1720 NICHOLASVILLE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1487
Mailing Address - Country:US
Mailing Address - Phone:859-278-1114
Mailing Address - Fax:859-277-0541
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-1114
Practice Address - Fax:859-277-0541
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1609283936207Y00000X
MN59516207Y00000X
390200000X
KY52806207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program