1912165226 NPI number — DR. BORIS LAZAREV M.D.

Table of content: DR. BORIS LAZAREV M.D. (NPI 1912165226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912165226 NPI number — DR. BORIS LAZAREV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZAREV
Provider First Name:
BORIS
Provider Middle Name:
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:
1912165226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34503 9TH AVE S
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003-8727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-261-0519
Provider Business Mailing Address Fax Number:
253-835-8000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34503 9TH AVE S
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-261-0519
Provider Business Practice Location Address Fax Number:
253-835-8000
Provider Enumeration Date:
05/23/2008

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: 207R00000X , with the licence number:  A109320 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD151159 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 246945 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD60613516 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1912165226 . This is a "ANTHEM NH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "BMC HEALTH NET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "FALLON COMMUNITY HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA265316 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0332515 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19121655226 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110093192A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912165226 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 935553-02 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912165226 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 32001664 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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