Provider Demographics
NPI:1700869856
Name:LASSEN, ARLO C (PA)
Entity Type:Individual
Prefix:MR
First Name:ARLO
Middle Name:C
Last Name:LASSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1309 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1005
Mailing Address - Country:US
Mailing Address - Phone:336-544-5400
Mailing Address - Fax:336-544-5401
Practice Address - Street 1:1309 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1005
Practice Address - Country:US
Practice Address - Phone:336-544-5400
Practice Address - Fax:336-544-5401
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP95860Medicare UPIN
NC2759203Medicare ID - Type Unspecified