Healthcare Provider Details

I. General information

NPI: 1275706673
Provider Name (Legal Business Name): LAZAROU UROLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WALNUT ST SUITE 460
WELLESLEY HILLS MA
02481-2118
US

IV. Provider business mailing address

10 NEHOIDEN STREET
NEEDHAM MA
02492-1932
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-9000
  • Fax: 781-237-9001
Mailing address:
  • Phone: 617-777-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number220000
License Number StateMA

VIII. Authorized Official

Name: DR. STEPHEN A LAZAROU
Title or Position: OWNER
Credential: M.D.
Phone: 617-777-0508