Healthcare Provider Details

I. General information

NPI: 1699924589
Provider Name (Legal Business Name): SUSAN KAUFMAN LAZEROW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DC VA MEDICAL CTR 50 IRVING STREET, NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

DC VA MEDICAL CTR 50 IRVING STREET, NW
WASHINGTON DC
20422-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8151
  • Fax:
Mailing address:
  • Phone: 202-745-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD034210
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: