Provider Demographics
NPI:1316630288
Name:LAZAROFF, ALEXANDER HARRISON
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HARRISON
Last Name:LAZAROFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MARENGO DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8948
Mailing Address - Country:US
Mailing Address - Phone:859-544-0417
Mailing Address - Fax:
Practice Address - Street 1:213 MARENGO DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8948
Practice Address - Country:US
Practice Address - Phone:859-544-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program