Provider Demographics
NPI:1326032681
Name:LAZAR, GERALD K (M D)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:K
Last Name:LAZAR
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CRAFTSLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2632
Mailing Address - Country:US
Mailing Address - Phone:617-731-1930
Mailing Address - Fax:
Practice Address - Street 1:32 CRAFTSLAND RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2632
Practice Address - Country:US
Practice Address - Phone:617-731-1930
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA321862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM08126OtherBLUE CROSS BLUE SHIELD
MAM08126Medicare ID - Type UnspecifiedMEDICARE
MAM08126OtherBLUE CROSS BLUE SHIELD