Provider Demographics
NPI:1982041042
Name:LAZAR, SUSAN GABER (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GABER
Last Name:LAZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9104 QUINTANA DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2040
Mailing Address - Country:US
Mailing Address - Phone:301-365-0373
Mailing Address - Fax:301-365-3240
Practice Address - Street 1:9104 QUINTANA DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2040
Practice Address - Country:US
Practice Address - Phone:301-365-0373
Practice Address - Fax:301-365-3240
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD205612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG95580Medicare UPIN