Healthcare Provider Details

I. General information

NPI: 1184649717
Provider Name (Legal Business Name): SVETISLAV LAZICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 LEBANON ST
MELROSE MA
02176
US

IV. Provider business mailing address

532 LEBANON ST
MELROSE MA
02176
US

V. Phone/Fax

Practice location:
  • Phone: 781-665-3237
  • Fax: 781-662-6452
Mailing address:
  • Phone: 781-665-3237
  • Fax: 781-662-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35303
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: