Provider Demographics
NPI:1184649717
Name:LAZICH, SVETISLAV (MD)
Entity type:Individual
Prefix:DR
First Name:SVETISLAV
Middle Name:
Last Name:LAZICH
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 1:532 LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-665-3237
Mailing Address - Fax:781-662-6452
Practice Address - Street 1:532 LEBANON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176
Practice Address - Country:US
Practice Address - Phone:781-665-3237
Practice Address - Fax:781-662-6452
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35303207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0147281Medicaid
MA0147281Medicaid
B97050Medicare UPIN