Healthcare Provider Details

I. General information

NPI: 1750395778
Provider Name (Legal Business Name): MARINA LAZBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17876 SAINT CLAIR AVE
CLEVELAND OH
44110
US

IV. Provider business mailing address

17876 SAINT CLAIR AVE
CLEVELAND OH
44110-2602
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-2222
  • Fax: 216-298-0241
Mailing address:
  • Phone: 216-383-2222
  • Fax: 216-298-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number35088100
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35.088100
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: