MEDICARE: ALAN LAZERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	26359	MA

General Provider Information

NPI Number	:	1902002330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN LAZERSON

Provider Business Mailing Address
First Line	:	25 MAIN ST
Second Line	:	SUITE 6
City	:	WAYLAND
State	:	MA
Zip	:	01778-5036
Country	:	US
Telephone Number	:	508-653-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MAIN ST
Second Line	:	SUITE 6
City	:	WAYLAND
State	:	MA
Zip	:	01778-5036
Country	:	US
Telephone Number	:	508-653-4741
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALAN LAZERSON
Credential	:	MD
Telephone Number	:	508-653-4741

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/22/2020

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