Provider Demographics
NPI:1740329283
Name:LAZATIN, SALVACION GARIN (MD)
Entity type:Individual
Prefix:MRS
First Name:SALVACION
Middle Name:GARIN
Last Name:LAZATIN
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 1:2412 BALDWIN MILL RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047
Mailing Address - Country:US
Mailing Address - Phone:410-557-9191
Mailing Address - Fax:
Practice Address - Street 1:2412 BALDWIN MILL RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047
Practice Address - Country:US
Practice Address - Phone:410-557-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19526208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
5190SGMedicare ID - Type Unspecified
B70761Medicare UPIN