Provider Demographics
NPI:1720192404
Name:LANASA, SALVATORE (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:LANASA
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 1:329 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2262
Mailing Address - Country:US
Mailing Address - Phone:814-445-3575
Mailing Address - Fax:814-445-5700
Practice Address - Street 1:126 E CHURCH ST STE 3200
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2273
Practice Address - Country:US
Practice Address - Phone:814-443-2100
Practice Address - Fax:814-443-2112
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20627208600000X
PAMD040204L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACI6140OtherRAILROAD MEDICARE
PA0015083500028Medicaid
PA002047198OtherHIGHMARK BLUE SHIELD
PA710929OtherMEDICARE
WV1000229000Medicaid