1871552158 NPI number — DR. ANGELINE ABRAHAM LAZARUS MD

Table of content: DR. ANGELINE ABRAHAM LAZARUS MD (NPI 1871552158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871552158 NPI number — DR. ANGELINE ABRAHAM LAZARUS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAZARUS
Provider First Name:
ANGELINE
Provider Middle Name:
ABRAHAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NITHIYANANDAN
Provider Other First Name:
ANGELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871552158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13207 VALLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-3626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-424-5752
Provider Business Mailing Address Fax Number:
301-319-8751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 WISCONSIN AVENUE
Provider Second Line Business Practice Location Address:
NATIONAL NAVAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20889-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-295-4218
Provider Business Practice Location Address Fax Number:
301-319-8751
Provider Enumeration Date:
03/23/2006

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: 207RP1001X , with the licence number:  D0062654 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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