Provider Demographics
NPI:1073578779
Name:SOUTH SHORE NEPHROLOGY, P.C.
Entity Type:Organization
Organization Name:SOUTH SHORE NEPHROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PIOTR
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:508-747-4883
Mailing Address - Street 1:47 OBERY STREET
Mailing Address - Street 2:STE 1A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2229
Mailing Address - Country:US
Mailing Address - Phone:508-747-4883
Mailing Address - Fax:508-747-6661
Practice Address - Street 1:47 OBERY STREET
Practice Address - Street 2:STE 1A
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2229
Practice Address - Country:US
Practice Address - Phone:508-747-4883
Practice Address - Fax:508-747-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA412162OtherTUFTS HEALTH PLAN PAYEE N
MA9749331Medicaid
MAM18774OtherBLUE SHIELD GROUP NUMBER
MAM18774OtherBLUE SHIELD GROUP NUMBER