Healthcare Provider Details

I. General information

NPI: 1982056826
Provider Name (Legal Business Name): LACHELLE MAUREEN LAZARUS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2016
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S EUTAW ST STE 400
BALTIMORE MD
21201-1699
US

IV. Provider business mailing address

3020 AUTUMN BRANCH LN APT J
ELLICOTT CITY MD
21043-3552
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5948
  • Fax:
Mailing address:
  • Phone: 954-682-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01487
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: