Basic Information
| Provider Information | |||||||||
| NPI: | 1720192404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANASA | ||||||||
| FirstName: | SALVATORE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 S PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144455700 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 E CHURCH ST STE 3200 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144432100 | ||||||||
| FaxNumber: | 8144432112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 20627 | WV | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD040204L | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | CI6140 | 01 | PA | RAILROAD MEDICARE | OTHER | 0015083500028 | 05 | PA | MEDICAID | 002047198 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 710929 | 01 | PA | MEDICARE | OTHER | 1000229000 | 05 | WV | MEDICAID |