1801884762 NPI number — ELIZABETH LAZARUS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801884762 NPI number — ELIZABETH LAZARUS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LAZARUS

Provider First Name:

ELIZABETH

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1801884762

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

125 METRO CENTER BLVD STE 2000

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WARWICK

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02886-1785

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-432-2520

Provider Business Mailing Address Fax Number:

401-453-8220

Provider First Line Business Practice Location Address:

593 EDDY ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PROVIDENCE

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02903-4923

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-444-5174

Provider Business Practice Location Address Fax Number:

401-453-8220

Provider Enumeration Date:

10/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  10057 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0202X , with the licence number: 203887 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 300103355 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 720086801 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 7007222 . This is a "RI MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 003116391 . This is a "CT MED ASSISTANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 010057 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0162001 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
• Identifier: 007007230 . This is a "HOSPITAL PIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 0162001 . This is a "MEDICAID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 241367 . This is a "RIH PILGRIM" identifier . This identifiers is of the category "OTHER".
• Identifier: 405083 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000001988 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
• Identifier: 400906 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1600025 . This is a "UNITED HEALTH PLUS" identifier . This identifiers is of the category "OTHER".