Provider Demographics
NPI:1629040357
Name:LASSMAN, MARSHALL NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:NATHAN
Last Name:LASSMAN
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 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-3245
Mailing Address - Fax:860-679-0121
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:STE 4310
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1770
Practice Address - Country:US
Practice Address - Phone:860-247-2137
Practice Address - Fax:860-728-0480
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015106207R00000X, 207RE0101X
CT0015106207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010015106CT01OtherBCBS
CT001151067Medicaid
CT015106OtherMEDICAL LICENSE
CTAL6461533OtherDEA
CT001151067Medicaid
CTAL6461533OtherDEA
B83300Medicare UPIN