Healthcare Provider Details

I. General information

NPI: 1528005998
Provider Name (Legal Business Name): CARLO LASCALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT ST ANESTHESIA DEPARTMENT
KEENE NH
03431-1719
US

IV. Provider business mailing address

590 COURT ST ANESTHESIA DEPARTMENT
KEENE NH
03431-1719
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5400
  • Fax:
Mailing address:
  • Phone: 603-354-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8166
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier80000233
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer
# 2
Identifier050031205
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILRAOD MEDICAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: