Provider Demographics
NPI:1063483527
Name:LAZOWICK, DANIEL C (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:LAZOWICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 461E
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3434
Mailing Address - Country:US
Mailing Address - Phone:610-649-6100
Mailing Address - Fax:610-649-5700
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:330 LANKENAU MOB WEST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-6555
Practice Address - Fax:610-649-4744
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008535L207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016533330007Medicaid
PA0016533330007Medicaid
PA000546HK1Medicare PIN