Healthcare Provider Details

I. General information

NPI: 1487864328
Provider Name (Legal Business Name): SUSAN G. LAZAR, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 QUINTANA DR
BETHESDA MD
20817-2040
US

IV. Provider business mailing address

9104 QUINTANA DR
BETHESDA MD
20817-2040
US

V. Phone/Fax

Practice location:
  • Phone: 301-365-0373
  • Fax: 301-365-3240
Mailing address:
  • Phone: 301-365-0373
  • Fax: 301-365-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberD20561
License Number StateMD

VIII. Authorized Official

Name: DR. SUSAN GABOR LAZAR
Title or Position: PRESIDENT
Credential: MD
Phone: 301-365-0373