Provider Demographics
NPI:1790838944
Name:LAZOR, PAUL (PHD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LAZOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 CAMPBELL BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5974
Mailing Address - Country:US
Mailing Address - Phone:410-931-9280
Mailing Address - Fax:410-931-9280
Practice Address - Street 1:5024 CAMPBELL BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5974
Practice Address - Country:US
Practice Address - Phone:410-931-9280
Practice Address - Fax:410-931-9280
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD1947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR12659Medicare UPIN