Basic Information
| Provider Information | |||||||||
| NPI: | 1801884762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAZARUS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10057 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 010057 | 01 | BCBS | OTHER | 003116391 | 01 | CT MED ASSISTANCE | OTHER | 007007230 | 01 | HOSPITAL PIN | OTHER | 300103355 | 01 | RR MEDICARE | OTHER | 720086801 | 01 | CIGNA | OTHER | 400906 | 01 | TUFTS | OTHER | 000000001988 | 01 | NHPRI | OTHER | 0162001 | 01 | HEALTHY START | OTHER | 0162001 | 01 | MA | MEDICAID | OTHER | 7007222 | 01 | RI MEDICAL ASSISTANCE | OTHER | 1600025 | 01 | UNITED HEALTH PLUS | OTHER | 405083 | 01 | BLUE CHIP | OTHER | 241367 | 01 | RIH PILGRIM | OTHER |