Provider Demographics
NPI:1700815982
Name:LASEK, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:LASEK
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 1:145 PINE HAVEN SHORES RD STE 1011
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7812
Mailing Address - Country:US
Mailing Address - Phone:802-448-0048
Mailing Address - Fax:802-209-5024
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1011
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7812
Practice Address - Country:US
Practice Address - Phone:802-488-0048
Practice Address - Fax:802-209-8024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00109182084P0800X
VT0420010918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011733Medicaid
VT1011733Medicaid