MEDICARE: MR. JOHN M LAZARO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	16869	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110180893	OTHER	SC	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	S309354	OTHER	SC	HEALTH SOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	53138	OTHER	SC	MEDCOST

General Provider Information

NPI Number	:	1649238684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN M LAZARO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6069
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-6069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 SUNSET CT
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-2429
Country	:	US
Telephone Number	:	803-796-2222
Fax Number	:	803-796-7839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/09/2020

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Directions to “ MR. JOHN M LAZARO M.D.” Practice Location

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