Healthcare Provider Details

I. General information

NPI: 1578627295
Provider Name (Legal Business Name): ERIC MICHAEL LASKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 OLD STREET RD
PETERBOROUGH NH
03458-1263
US

IV. Provider business mailing address

88 PIERCE RD
DUBLIN NH
03444-8657
US

V. Phone/Fax

Practice location:
  • Phone: 603-924-7191
  • Fax:
Mailing address:
  • Phone: 603-563-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number13407
License Number StateNH

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: