Provider Demographics
NPI:1023197902
Name:MILLS, LAWRENCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:MILLS
Suffix:JR
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 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:SUITE 302 PROFESSIONAL BLDG
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2995
Mailing Address - Country:US
Mailing Address - Phone:410-532-4372
Mailing Address - Fax:410-532-4371
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:SUITE 302 PROFESSIONAL BLDG
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2995
Practice Address - Country:US
Practice Address - Phone:410-532-4372
Practice Address - Fax:410-532-4371
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD12809207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS6046OtherBLUE SHIELD
MD152711800Medicaid
T128OtherBLUE CHOICE BLUE SHIELD
D73774Medicare UPIN
BS6046OtherBLUE SHIELD