Healthcare Provider Details

I. General information

NPI: 1467655795
Provider Name (Legal Business Name): MARJORIE LAZOFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S WASHINGTON SQ #2712
PHILADELPHIA PA
19106-4118
US

IV. Provider business mailing address

604 S WASHINGTON SQ #2712
PHILADELPHIA PA
19106-4118
US

V. Phone/Fax

Practice location:
  • Phone: 215-238-6524
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD042606E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: