Provider Demographics
NPI:1467472894
Name:LAZOR, SANDRA L (PA-C)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:LAZOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE BUILDING E SUITE 3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601
Mailing Address - Country:US
Mailing Address - Phone:814-889-3930
Mailing Address - Fax:814-944-2403
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:ALTOONA REGIONAL HEALTH SYSTEM
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-946-1655
Practice Address - Fax:814-949-7616
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP38706Medicare UPIN
PA109401Medicare PIN