Provider Demographics
NPI:1164424081
Name:LAZAR, ANDREW E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:LAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3619 PARK EAST DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4312
Mailing Address - Country:US
Mailing Address - Phone:216-896-0639
Mailing Address - Fax:216-896-0663
Practice Address - Street 1:3619 PARK EAST DR STE 110
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4312
Practice Address - Country:US
Practice Address - Phone:216-896-0639
Practice Address - Fax:216-896-0663
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35081307L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333960Medicaid
OHH34227Medicare UPIN
OH2333960Medicaid
OHH34227Medicare UPIN