Healthcare Provider Details

I. General information

NPI: 1497980429
Provider Name (Legal Business Name): BENIGNO PALAFOX LAZARO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BEN P. LAZARO JR. M.D.

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ARLINGTON AVE SUITE 100
BALTIMORE MD
21223-2671
US

IV. Provider business mailing address

4910 LINDA AVE
BALTIMORE MD
21236-3813
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7180
  • Fax:
Mailing address:
  • Phone: 443-414-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0046974
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: