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NPI Code Detail

MEDICARE: JOHN LAZZARI

MEDICARE: JOHN LAZZARI
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
1363A00000XPhysician Assistant0010-11453NC
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1730785791
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN LAZZARI
Provider Business Mailing Address
First Line : PO BOX 5105
Second Line :
City : BELFAST
State : ME
Zip : 04915-5100
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Provider Business Practice Location Address
First Line : 2716 ASHTON DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2489
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2020
Last Update Date : 01/07/2026

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