Provider Demographics
NPI:1912165226
Name:LAZAREV, BORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:LAZAREV
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 1:34503 9TH AVE S
Mailing Address - Street 2:STE 100
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8727
Mailing Address - Country:US
Mailing Address - Phone:253-261-0519
Mailing Address - Fax:253-835-8000
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:STE 100
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-261-0519
Practice Address - Fax:253-835-8000
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109320207R00000X
ORMD151159207R00000X
MA246945207R00000X
WAMD60613516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912165226OtherANTHEM NH
MA1912165226OtherUNITED HEALTHCARE
MA1912165226OtherEVERCARE
MA1912165226OtherBMC HEALTH NET PLAN
MA1912165226OtherFALLON COMMUNITY HEALTH PLAN
MAAA265316OtherHARVARD PILGRIM HEALTH CARE
MA0332515OtherCIGNA HEALTH CARE
MA19121655226OtherAETNA
MA1912165226OtherNEIGHBORHOOD HEALTH PLAN
MA110093192AMedicaid
MA1912165226OtherBCBS
MA1912165226OtherPHCS
MA935553-02OtherNETWORK HEALTH
CAPENDINGOtherMEDICARE
MA1912165226OtherTUFTS HEALTH PLAN
NH32001664Medicaid
MA1912165226OtherUNITED HEALTHCARE