Provider Demographics
NPI:1740324987
Name:LAZNICKOVA, HANA M (MD)
Entity type:Individual
Prefix:DR
First Name:HANA
Middle Name:M
Last Name:LAZNICKOVA
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 1:16 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4988
Mailing Address - Country:US
Mailing Address - Phone:781-861-2049
Mailing Address - Fax:781-861-1502
Practice Address - Street 1:16 CLARKE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4988
Practice Address - Country:US
Practice Address - Phone:781-861-2049
Practice Address - Fax:781-861-1502
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155111207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA51340OtherFALLON
MAAA11049OtherHARVARD PILGRIM
MAJ22438OtherBLUE CROSS BLUE SHIELD
MA155111OtherMA STATE LICENSE
MAAA11049OtherHARVARD PILGRIM
20-0624810OtherEIN