Provider Demographics
NPI:1427023944
Name:LAZRIS, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LAZRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 CEDAR LN STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3898
Mailing Address - Country:US
Mailing Address - Phone:410-531-2355
Mailing Address - Fax:410-531-7041
Practice Address - Street 1:6334 CEDAR LN STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3898
Practice Address - Country:US
Practice Address - Phone:410-531-2355
Practice Address - Fax:410-531-7041
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008203100Medicaid
MD380651100Medicaid
53498303OtherCAREFIRST BCBS
04-03155OtherEVERCARE
MDDPC6ALOtherCARE FIRST
MD380651100Medicaid
9860CMedicare PIN
MDF61889Medicare UPIN
MD008203100Medicaid