Provider Demographics
NPI:1609901057
Name:LACOGNATA, SALVATORE G (DO)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:G
Last Name:LACOGNATA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 E BASELINE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2750
Mailing Address - Country:US
Mailing Address - Phone:480-969-3531
Mailing Address - Fax:480-269-9465
Practice Address - Street 1:3941 E BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2750
Practice Address - Country:US
Practice Address - Phone:480-969-3531
Practice Address - Fax:480-269-9465
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3700207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628737Medicaid
AZH24875Medicare UPIN
AZ628737Medicaid