Provider Demographics
NPI:1881652576
Name:LAZAR, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PEOPLES PLZ
Mailing Address - Street 2:SUITE 305
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5707
Mailing Address - Country:US
Mailing Address - Phone:302-838-2210
Mailing Address - Fax:302-838-2129
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 305
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-838-2210
Practice Address - Fax:302-838-2129
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000605801Medicaid
F95636Medicare UPIN
DE577511ZCU9Medicare PIN
DE000605801Medicaid