Individual
DR. MATTHEW R LASALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD18342
OR
207R00000X
Internal Medicine Physician
Primary
MD18342
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082057
—
OR
01
—
P00422276
MEDICARE RAILROAD
OR
Enumeration date
10/03/2006
Last updated
04/06/2021
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