Provider Demographics
NPI:1487864328
Name:SUSAN G. LAZAR, MD, PA
Entity Type:Organization
Organization Name:SUSAN G. LAZAR, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GABOR
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-365-0373
Mailing Address - Street 1:9104 QUINTANA DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2040
Mailing Address - Country:US
Mailing Address - Phone:301-365-0373
Mailing Address - Fax:301-365-3240
Practice Address - Street 1:9104 QUINTANA DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2040
Practice Address - Country:US
Practice Address - Phone:301-365-0373
Practice Address - Fax:301-365-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20561102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490354Medicare ID - Type UnspecifiedMEDICARE