Basic Information
| Provider Information | |||||||||
| NPI: | 1912165226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAZAREV | ||||||||
| FirstName: | BORIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532610519 | ||||||||
| FaxNumber: | 2538358000 | ||||||||
| Practice Location | |||||||||
| Address1: | 34503 9TH AVE S | ||||||||
| Address2: | STE 100 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980038727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532610519 | ||||||||
| FaxNumber: | 2538358000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 08/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A109320 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD151159 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 246945 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD60613516 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1912165226 | 01 | ANTHEM NH | OTHER | 1912165226 | 01 | MA | UNITED HEALTHCARE | OTHER | 1912165226 | 01 | MA | EVERCARE | OTHER | 1912165226 | 01 | MA | BMC HEALTH NET PLAN | OTHER | 1912165226 | 01 | MA | FALLON COMMUNITY HEALTH PLAN | OTHER | AA265316 | 01 | MA | HARVARD PILGRIM HEALTH CARE | OTHER | 0332515 | 01 | MA | CIGNA HEALTH CARE | OTHER | 19121655226 | 01 | MA | AETNA | OTHER | 1912165226 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 110093192A | 05 | MA | MEDICAID | 1912165226 | 01 | MA | BCBS | OTHER | 1912165226 | 01 | MA | PHCS | OTHER | 935553-02 | 01 | MA | NETWORK HEALTH | OTHER | PENDING | 01 | CA | MEDICARE | OTHER | 1912165226 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 32001664 | 05 | NH | MEDICAID |