MEDICARE: IGOR LOMAZOFF 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	207N00000X	Dermatology Physician	MD421026	PA
2	207ND0900X	Dermatopathology Physician	MD421026	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2213217000	OTHER	PA	KEYSTONE HP EAST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3310054	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1790789733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR LOMAZOFF M.D.

Provider Business Mailing Address
First Line	:	501 OFFICE CENTER DR
Second Line	:	SUITE 195
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-3220
Country	:	US
Telephone Number	:	215-836-7900
Fax Number	:	215-836-7923

Provider Business Practice Location Address
First Line	:	501 OFFICE CENTER DR
Second Line	:	SUITE 195
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-3220
Country	:	US
Telephone Number	:	215-836-7900
Fax Number	:	215-836-7923

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/25/2007

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Directions to “ IGOR LOMAZOFF M.D.” Practice Location

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