Healthcare Provider Details

I. General information

NPI: 1447373022
Provider Name (Legal Business Name): ELIZABETH LAZAROFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PLAGEMAN BLDG
CORVALLIS OR
97331-8567
US

IV. Provider business mailing address

213 WATER AVE NW STE 300
ALBANY OR
97321-2279
US

V. Phone/Fax

Practice location:
  • Phone: 541-737-9355
  • Fax: 541-737-9665
Mailing address:
  • Phone: 541-928-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD18620
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD18620
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: