Provider Demographics
NPI:1033322953
Name:JERROLD A. LASKIN, M.D., P.C.
Entity type:Organization
Organization Name:JERROLD A. LASKIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:LASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-706-9600
Mailing Address - Street 1:12425 OLD MERIDIAN ST
Mailing Address - Street 2:SUITE B1
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8724
Mailing Address - Country:US
Mailing Address - Phone:317-706-9600
Mailing Address - Fax:317-706-9606
Practice Address - Street 1:12425 OLD MERIDIAN ST
Practice Address - Street 2:SUITE B1
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8724
Practice Address - Country:US
Practice Address - Phone:317-706-9600
Practice Address - Fax:317-706-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040371208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091454OtherANTHEM PIN
IN000000091454OtherANTHEM PIN
INDG4430Medicare PIN
INF31449Medicare UPIN