Provider Demographics
NPI:1982316204
Name:LASTOVA, KEVIN (PA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LASTOVA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6022 COPELY LN
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2507
Mailing Address - Country:US
Mailing Address - Phone:571-249-9754
Mailing Address - Fax:
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR STE 700
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4529
Practice Address - Country:US
Practice Address - Phone:703-277-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant