Provider Demographics
NPI:1801817705
Name:POMERANIEC, LAZARO N (MD)
Entity type:Individual
Prefix:DR
First Name:LAZARO
Middle Name:N
Last Name:POMERANIEC
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:ONE POST ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6241
Mailing Address - Country:US
Mailing Address - Phone:203-255-7617
Mailing Address - Fax:203-255-7633
Practice Address - Street 1:ONE POST ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6241
Practice Address - Country:US
Practice Address - Phone:203-255-7617
Practice Address - Fax:203-255-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0260402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001260405Medicaid
260000811Medicare ID - Type Unspecified
CT001260405Medicaid