Healthcare Provider Details

I. General information

NPI: 1497049563
Provider Name (Legal Business Name): CHRISTOPHER R. LAZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTOPHER RYAN VILLAVICENCIO-LAZO M.D.

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST FL 1
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-6888
  • Fax: 434-243-6999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6516
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101260032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: