Provider Demographics
NPI:1790789733
Name:LOMAZOFF, IGOR (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:LOMAZOFF
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 1:501 OFFICE CENTER DR
Mailing Address - Street 2:SUITE 195
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3220
Mailing Address - Country:US
Mailing Address - Phone:215-836-7900
Mailing Address - Fax:215-836-7923
Practice Address - Street 1:501 OFFICE CENTER DR
Practice Address - Street 2:SUITE 195
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3220
Practice Address - Country:US
Practice Address - Phone:215-836-7900
Practice Address - Fax:215-836-7923
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421026207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2213217000OtherKEYSTONE HP EAST
PA01972602Medicaid
PA3310054OtherAETNA
H76872Medicare UPIN
PA01972602Medicaid