Provider Demographics
NPI:1629039615
Name:LASSER, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:LASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 STEVENS FOREST RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3231
Mailing Address - Country:US
Mailing Address - Phone:443-259-3770
Mailing Address - Fax:443-259-3775
Practice Address - Street 1:6350 STEVENS FOREST RD
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3231
Practice Address - Country:US
Practice Address - Phone:443-259-3770
Practice Address - Fax:443-259-3775
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE77265Medicare UPIN