Provider Demographics
NPI:1447320460
Name:WLAZ, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:WLAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-1601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 GEORGE ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-1601
Practice Address - Country:US
Practice Address - Phone:508-944-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42944208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0109886Medicaid
S009570OtherCHAMPUS GROUP NUMBER
MA238074Medicaid
MAM14099OtherMA BCBS GROUP NUMBER
RI4142-3OtherRI BCBS GROUP NUMBER
MA9741836Medicaid
MA238074Medicaid
MAM14099Medicare ID - Type UnspecifiedGROUP NUMBER