Provider Demographics
NPI:1972512556
Name:LAZEROV, JESSICA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNE
Last Name:LAZEROV
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 1:1011 N CAPITOL ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4236
Mailing Address - Country:US
Mailing Address - Phone:202-898-5398
Mailing Address - Fax:202-898-5282
Practice Address - Street 1:1011 N CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4236
Practice Address - Country:US
Practice Address - Phone:202-898-5398
Practice Address - Fax:202-898-5282
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034809208000000X
MDD0061743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics