Provider Demographics
NPI:1184774200
Name:LAZIC-MAZLAGIC, BRANKICA (MD)
Entity type:Individual
Prefix:
First Name:BRANKICA
Middle Name:
Last Name:LAZIC-MAZLAGIC
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:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-3238
Mailing Address - Country:US
Mailing Address - Phone:866-689-8862
Mailing Address - Fax:207-347-7407
Practice Address - Street 1:ONE HOPPIN ST.
Practice Address - Street 2:CORO CENTER 3RD FLR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4141
Practice Address - Country:US
Practice Address - Phone:401-793-8790
Practice Address - Fax:401-793-8709
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230847207R00000X
RIMD13072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine