Healthcare Provider Details

I. General information

NPI: 1972845808
Provider Name (Legal Business Name): JOSEPH PAUL LAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 04/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE HOUSE STAFF, PAVILION 129
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE HOUSE STAFF, PAVILION 129
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-7144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number265731
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: