Provider Demographics
NPI:1063449932
Name:CHARNAS, LAWRENCE RICHARD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:CHARNAS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 295
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-7466
Mailing Address - Fax:612-624-7681
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-672-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41594207SG0201X, 207SG0202X, 207SG0203X, 2084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN05-00109OtherMEDICA CHOICE
IA0531574Medicaid
WI34011800Medicaid
MT0051816Medicaid
MN41R80CHOtherBCBS
MN562482700Medicaid
GA000918541XMedicaid
MN05-00009OtherMEDICA PRIMARY
MN126488OtherUCARE
MN1025053OtherPREFERRED ONE
MNHP28906OtherHEALTHPARTNERS
KS2087310201Medicaid
MN236273OtherARAZ
KY64036122Medicaid
MN41R80CHOtherBCBS
MN1025053OtherPREFERRED ONE