Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35303 | MA |
NPI | 1184649717 |
---|---|
Provider Name | Dr. Svetislav Lazich |
First Address | Melrose, MA 02176 |
Second Address | Melrose, MA 02176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 01/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0147281 | (05) | MA |
B97050 | (02) |