Healthcare Provider Details

I. General information

NPI: 1700413572
Provider Name (Legal Business Name): SAMANTHA JO LASKO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JO STORTI

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3131
  • Fax:
Mailing address:
  • Phone: 412-359-3131
  • Fax: 708-684-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.076548
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOT022727
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: