Provider Demographics
NPI:1073177846
Name:DEBELLIS, LAWRENCE PAUL-ANTHONY (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PAUL-ANTHONY
Last Name:DEBELLIS
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:96 JONATHAN LUCAS ST STE 822
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:438-792-2529
Mailing Address - Fax:843-792-4114
Practice Address - Street 1:96 JONATHAN LUCAS ST STE 822
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-5754
Practice Address - Country:US
Practice Address - Phone:843-792-2529
Practice Address - Fax:843-792-4114
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS18937207R00000X, 208M00000X
SCMDO.89993LL207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKPPJMOtherBCBS
FL114762600Medicaid