Healthcare Provider Details

I. General information

NPI: 1033292289
Provider Name (Legal Business Name): NORMAND HENRY LAZAROW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HARBOR HILL RD
WOODS HOLE MA
02543-1215
US

IV. Provider business mailing address

16 HARBOR HILL RD
WOODS HOLE MA
02543-1215
US

V. Phone/Fax

Practice location:
  • Phone: 508-548-5860
  • Fax: 508-548-5860
Mailing address:
  • Phone: 508-548-5860
  • Fax: 508-548-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number233628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: