Individual
LEN B LASTINGER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
199 HOSPITAL DR, SUITE 5, GALAX, VA 24333-2454
(276) 236-6136
(276) 236-2536
Mailing address
103 1ST AVE, GALAX, VA 24333-2019
(540) 236-3465
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101-031905
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005816700
—
VA
05
—
006092870
—
VA
05
—
010026466
—
VA
Enumeration date
12/01/2005
Last updated
08/12/2011
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