Provider Demographics
NPI:1922144328
Name:LAKESIDE MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:LAKESIDE MEMORIAL HOSPITAL INC.
Other - Org Name:GENESEE FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-768-2620
Mailing Address - Street 1:8745 LAKE STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-9344
Mailing Address - Country:US
Mailing Address - Phone:585-768-2620
Mailing Address - Fax:585-768-2694
Practice Address - Street 1:8745 LAKE STREET RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9344
Practice Address - Country:US
Practice Address - Phone:585-768-2620
Practice Address - Fax:585-768-2694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKESIDE MEMORIAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty