Provider Demographics
NPI:1437133014
Name:LAZOR, GENEROSA CALDERON (MD)
Entity Type:Individual
Prefix:DR
First Name:GENEROSA
Middle Name:CALDERON
Last Name:LAZOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2014 S TOLLGATE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5903
Mailing Address - Country:US
Mailing Address - Phone:410-569-9533
Mailing Address - Fax:410-569-1254
Practice Address - Street 1:2014 S TOLLGATE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5903
Practice Address - Country:US
Practice Address - Phone:410-569-9533
Practice Address - Fax:410-569-1254
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408959600Medicaid
MDD34413OtherMD LICENSE NUMBER
MD293901100Medicaid
MDE16785Medicare UPIN