Healthcare Provider Details

I. General information

NPI: 1437133014
Provider Name (Legal Business Name): GENEROSA CALDERON LAZOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S TOLLGATE RD SUITE 200
BEL AIR MD
21015-5903
US

IV. Provider business mailing address

2014 S TOLLGATE RD SUITE 200
BEL AIR MD
21015-5903
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-9533
  • Fax: 410-569-1254
Mailing address:
  • Phone: 410-569-9533
  • Fax: 410-569-1254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD34413
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: