Provider Demographics
NPI:1659361004
Name:LAMASTRO, MARK WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:LAMASTRO
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 1:728 KING ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-939-8858
Mailing Address - Fax:914-939-3814
Practice Address - Street 1:728 KING ST.
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-939-8858
Practice Address - Fax:914-939-3814
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185 362 1207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0007752423OtherAETNA US HEALTHCARE PPO
NY5398370OtherGHI
NYP2742862OtherOXFORD
NY3021392OtherAETNA US HEALTHCARE HMO
NY8K818OtherEMPIRE BC BS
NY0007752423OtherAETNA US HEALTHCARE PPO
F01302Medicare UPIN