Provider Demographics
NPI:1306198213
Name:LEA LAZAR, M.D., P.C.
Entity Type:Organization
Organization Name:LEA LAZAR, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-531-1440
Mailing Address - Street 1:6355 TEN OAKS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1185
Mailing Address - Country:US
Mailing Address - Phone:410-531-1440
Mailing Address - Fax:410-531-1412
Practice Address - Street 1:6355 TEN OAKS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1185
Practice Address - Country:US
Practice Address - Phone:410-531-1440
Practice Address - Fax:410-531-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD38833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE16798Medicare UPIN