Provider Demographics
NPI:1215184569
Name:LAZICH, IVANA (MD)
Entity Type:Individual
Prefix:DR
First Name:IVANA
Middle Name:
Last Name:LAZICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2904
Mailing Address - Country:US
Mailing Address - Phone:978-531-0677
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 306
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2904
Practice Address - Country:US
Practice Address - Phone:978-531-0677
Practice Address - Fax:978-531-5676
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261159207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA261159OtherMASSACHUSETS LICENSE NUMBER