Provider Demographics
NPI:1942321179
Name:LASTAVICA, CATHERINE C (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:LASTAVICA
Suffix:
Gender:F
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:PO BOX 1443
Mailing Address - Street 2:9 COOLIDGE POINT
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-0870
Mailing Address - Country:US
Mailing Address - Phone:978-526-1641
Mailing Address - Fax:
Practice Address - Street 1:9 COOLIDGE POINT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-0870
Practice Address - Country:US
Practice Address - Phone:978-526-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27547207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease