Provider Demographics
NPI:1669428488
Name:LASTER, ANDREW JAY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAY
Last Name:LASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 RANDOLPH RD STE 600
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1198
Mailing Address - Country:US
Mailing Address - Phone:704-342-0252
Mailing Address - Fax:980-533-7806
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:STE 600
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-342-0252
Practice Address - Fax:980-533-7801
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26557207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0252259005OtherCIGNA
NC8951082Medicaid
NC577891OtherMAMSI
NC660003245OtherRAILROAD MEDICARE
NCA7355OtherMEDCOST
NC2617926OtherAETNA- HMO
NC4229682OtherAETNA - NON-HMO
NC104645OtherCOVENTRY
NC23352OtherPARTNERS
NC51082OtherBCBS
NC2617926OtherAETNA- HMO
NC8951082Medicaid