Healthcare Provider Details

I. General information

NPI: 1922042878
Provider Name (Legal Business Name): GERALD LAZARUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64252
BALTIMORE MD
21264-4252
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5933
  • Fax:
Mailing address:
  • Phone: 410-550-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD58423
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: