Healthcare Provider Details

I. General information

NPI: 1962469163
Provider Name (Legal Business Name): DAN LAZARESCU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W 24TH ST
ASHTABULA OH
44004-3423
US

IV. Provider business mailing address

2422 LAKE AVE
ASHTABULA OH
44004-4985
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-4422
  • Fax:
Mailing address:
  • Phone: 440-992-4422
  • Fax: 440-997-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35071063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: