Provider Demographics
NPI:1982742292
Name:LAZARO, ILUMINADA ILAW (MD)
Entity Type:Individual
Prefix:DR
First Name:ILUMINADA
Middle Name:ILAW
Last Name:LAZARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ILUMINADA
Other - Middle Name:ILAW
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6917 PINECREST ROAD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-455-0192
Mailing Address - Fax:
Practice Address - Street 1:501 CHERRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:443-872-7800
Practice Address - Fax:443-872-7803
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG43153Medicare ID - Type Unspecified