Provider Demographics
NPI:1457302804
Name:LASSITER, LONNIE W II (MD)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:W
Last Name:LASSITER
Suffix:II
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SPARKS DR
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-9021
Mailing Address - Country:US
Mailing Address - Phone:828-351-6000
Mailing Address - Fax:828-894-5864
Practice Address - Street 1:112 SPARKS DR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-9021
Practice Address - Country:US
Practice Address - Phone:828-351-6000
Practice Address - Fax:828-894-5864
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000005092083P0011X
NC2000-00509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126VPMedicaid
NC126VPOtherBCBS
2280555Medicare ID - Type Unspecified
NC89126VPMedicaid