Healthcare Provider Details

I. General information

NPI: 1104332774
Provider Name (Legal Business Name): DARIUS LUCIAN LAZARUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS STREET MUSC - CSB 822 / MSC 629
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0547
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number51848
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: