Healthcare Provider Details

I. General information

NPI: 1639199763
Provider Name (Legal Business Name): JOEL STEVEN LAZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALLEN ST
HANOVER NH
03755-2065
US

IV. Provider business mailing address

101 TREMONT STREET, 6TH FLOOR
BOSTON MA
02108
US

V. Phone/Fax

Practice location:
  • Phone: 603-738-1164
  • Fax: 603-653-8191
Mailing address:
  • Phone: 617-804-5981
  • Fax: 617-701-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12069
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: