Provider Demographics
NPI:1104566751
Name:LAZAR, IVAN (DO)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
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 1:151 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9002
Mailing Address - Country:US
Mailing Address - Phone:978-335-6321
Mailing Address - Fax:
Practice Address - Street 1:123 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-257-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program