Healthcare Provider Details

I. General information

NPI: 1811158710
Provider Name (Legal Business Name): KATHLEEN LAZARE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 SCHOOLHOUSE RD
GHENT NY
12075-4028
US

IV. Provider business mailing address

278 SCHOOLHOUSE RD
GHENT NY
12075-4028
US

V. Phone/Fax

Practice location:
  • Phone: 518-755-4936
  • Fax:
Mailing address:
  • Phone: 518-755-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number254105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: