1033408836 NPI number — DR. BRYAN M LAZZARA M.D.

Table of content: DR. BRYAN M LAZZARA M.D. (NPI 1033408836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033408836 NPI number — DR. BRYAN M LAZZARA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZZARA
Provider First Name:
BRYAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033408836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5655 HUDSON DR STE 210
Provider Second Line Business Mailing Address:
ARIS RADIOLOGY
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44236-4455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-655-1869
Provider Business Mailing Address Fax Number:
330-655-3828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5655 HUDSON DR STE 210
Provider Second Line Business Practice Location Address:
ARIS RADIOLOGY
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44236-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-655-1869
Provider Business Practice Location Address Fax Number:
330-655-3828
Provider Enumeration Date:
04/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085N0700X , with the licence number:  036.127350 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 036.127350 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)