Provider Demographics
NPI:1689694275
Name:LAMASTRA, PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:LAMASTRA
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 1:573 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-7207
Mailing Address - Country:US
Mailing Address - Phone:203-255-2230
Mailing Address - Fax:203-255-2283
Practice Address - Street 1:1735 POST RD
Practice Address - Street 2:OB/GYN OF FAIRFIELD COUNTY
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5782
Practice Address - Country:US
Practice Address - Phone:203-256-3990
Practice Address - Fax:203-255-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001126549Medicaid
CT160002169Medicare UPIN
CT001126549Medicaid