Healthcare Provider Details

I. General information

NPI: 1275684771
Provider Name (Legal Business Name): SCOTT CHRISTOPHER LASTRAPES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14636 ROTHGEB DR
ROCKVILLE MD
20850-5394
US

IV. Provider business mailing address

6000 MERRIWEATHER DR UNIT 7072
COLUMBIA MD
21044-4468
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-5300
  • Fax:
Mailing address:
  • Phone: 240-383-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD036365
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD0065625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: