Provider Demographics
NPI:1104566751
Name:LAZAR, IVAN PETROVYCH (DO)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:PETROVYCH
Last Name:LAZAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 ELKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2211
Mailing Address - Country:US
Mailing Address - Phone:828-257-4747
Mailing Address - Fax:828-257-4763
Practice Address - Street 1:218 ELKWOOD AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2211
Practice Address - Country:US
Practice Address - Phone:828-257-4747
Practice Address - Fax:828-257-4763
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-01603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine