Provider Demographics
NPI:1629173315
Name:LASTINGER, LINDA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:T
Last Name:LASTINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2407
Mailing Address - Country:US
Mailing Address - Phone:276-236-0065
Mailing Address - Fax:
Practice Address - Street 1:961 E STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2407
Practice Address - Country:US
Practice Address - Phone:276-236-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1010319606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA302298OtherSOUTHERN HEALTH
NC84641OtherMED-COST (NORTH CAROLINA)
VA005814120Medicaid
VA283020OtherANTHEM
NC84641OtherMED-COST (NORTH CAROLINA)
VA110007120Medicare ID - Type Unspecified
VA005814120Medicaid