Provider Demographics
NPI:1942334040
Name:LAZZARO, BETTE (MD)
Entity type:Individual
Prefix:DR
First Name:BETTE
Middle Name:
Last Name:LAZZARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2119
Mailing Address - Country:US
Mailing Address - Phone:215-432-3099
Mailing Address - Fax:610-524-8099
Practice Address - Street 1:819 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4158
Practice Address - Country:US
Practice Address - Phone:302-888-0213
Practice Address - Fax:610-524-8099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006098207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02964863Medicaid
NYP00677226OtherRAILROAD MEDICARE
NY47Y21WS421Medicare PIN
F49610Medicare UPIN