Provider Demographics
NPI:1619177250
Name:CARBONE-LAZARUS, JEANINE F (MD)
Entity type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:F
Last Name:CARBONE-LAZARUS
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:PO BOX 744069 DEPT 50028
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4069
Mailing Address - Country:US
Mailing Address - Phone:954-939-5000
Mailing Address - Fax:305-669-9735
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:STE 309
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-499-4352
Practice Address - Fax:954-242-6600
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005085207VM0101X
FLME113051207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005945800Medicaid