Provider Demographics
NPI:1801919832
Name:LAZARUS, TADD SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:TADD
Middle Name:SCOTT
Last Name:LAZARUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10210 GENETIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4362
Mailing Address - Country:US
Mailing Address - Phone:858-410-8086
Mailing Address - Fax:858-410-8190
Practice Address - Street 1:10210 GENETIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4362
Practice Address - Country:US
Practice Address - Phone:858-410-8086
Practice Address - Fax:858-410-8190
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176336-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01277334Medicaid
NY03G83Medicare ID - Type Unspecified
NYF20860Medicare UPIN