Provider Demographics
NPI:1609958677
Name:LASKY, MARK LESTER (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LESTER
Last Name:LASKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 WELLINGTON FARMS PL
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1204
Mailing Address - Country:US
Mailing Address - Phone:804-778-7434
Mailing Address - Fax:877-874-1008
Practice Address - Street 1:10701 WELLINGTON FARMS PL
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1204
Practice Address - Country:US
Practice Address - Phone:804-778-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine