Tania A Laslovich, A.T.C.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1742 Issued in MA

Practice address

100 Edgartown Road
Oak Bluffs, MA 02557

Phone

(508) 693-1033

NPI assigned

Apr 27, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Tania A Dmitri Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356561625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4012",
            "city": "VINEYARD HAVEN",
            "state": "MA",
            "postal_code": "025680928",
            "telephone_number": "508-693-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EDGARTOWN ROAD",
            "city": "OAK BLUFFS",
            "state": "MA",
            "postal_code": "02557",
            "telephone_number": "508-693-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASLOVICH",
        "first_name": "TANIA",
        "middle_name": "A",
        "credential": "A.T.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "1742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATA MEMBER DISTRICT 1",
            "identifier": "960212",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA AHP LICENSE",
            "identifier": "1742",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TANIA",
            "last_name": "DMITRI",
            "middle_name": "A",
            "credential": "A.T.C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stuart A Kendall, MD
• Kimberly V Burke
• Stephen Chii-Ming Ko, MD MA MPH MDIV
• Richard Hudson Koehler, M.D.
• John R. Lamb, M.D.
• Peter J Laursen, MD
• Michele Lazerow, DC, LIC.AC.
• Michele Denise Leblanc, RN, BSN
• Nancy E Leport, CNM
• Lifeguard Medical Group,LLC

• All providers in Oak Bluffs, MA
• Athletic Trainer in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.