Provider Demographics
NPI:1356304158
Name:DANZIGER-ISAKOV, LARA A (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:A
Last Name:DANZIGER-ISAKOV
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 6014
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4578
Mailing Address - Fax:513-636-7039
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 6014
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4578
Practice Address - Fax:513-636-7039
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075405D2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411572Medicaid