Provider Demographics
NPI:1285613521
Name:LAZOS, VASILIOS P (DO)
Entity type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:P
Last Name:LAZOS
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 1:764 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5210
Mailing Address - Country:US
Mailing Address - Phone:603-669-3925
Mailing Address - Fax:
Practice Address - Street 1:764 2ND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5210
Practice Address - Country:US
Practice Address - Phone:603-669-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002513A208D00000X
NH14843207W00000X
GA061912207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076290Medicaid