Provider Demographics
NPI:1497980429
Name:LAZARO, BENIGNO PALAFOX JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BENIGNO
Middle Name:PALAFOX
Last Name:LAZARO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:P
Other - Last Name:LAZARO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4910 LINDA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3813
Mailing Address - Country:US
Mailing Address - Phone:443-414-1401
Mailing Address - Fax:
Practice Address - Street 1:200 S ARLINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2671
Practice Address - Country:US
Practice Address - Phone:410-962-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine