Healthcare Provider Details

I. General information

NPI: 1639675358
Provider Name (Legal Business Name): ALEXANDRA LAZZARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE JOHNS HOPKINS HOSPITAL 1800 ORLEANS STREET
BALTIMORE MD
21287
US

IV. Provider business mailing address

15 LAKELAND RD
STATEN ISLAND NY
10314-2505
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberD0091650
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0091650
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: