Healthcare Provider Details

I. General information

NPI: 1144580085
Provider Name (Legal Business Name): JONATHAN I LAZZARA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4449 STATE ROUTE 159
CHILLICOTHE OH
45601-8620
US

IV. Provider business mailing address

200 MEDICAL CENTER DR
MIDDLETOWN OH
45005-5200
US

V. Phone/Fax

Practice location:
  • Phone: 740-775-1260
  • Fax: 740-773-1264
Mailing address:
  • Phone: 513-974-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101278859
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.011075
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34.011075
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: