Provider Demographics
NPI:1619958899
Name:LAZARIDES, LAZAROS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAZAROS
Middle Name:
Last Name:LAZARIDES
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 1:1453 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1153
Mailing Address - Country:US
Mailing Address - Phone:203-389-4111
Mailing Address - Fax:203-889-4953
Practice Address - Street 1:1453 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1153
Practice Address - Country:US
Practice Address - Phone:203-389-4111
Practice Address - Fax:203-889-4953
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431311Medicaid
CTI34437Medicare UPIN
CTD400103194Medicare PIN