Provider Demographics
NPI:1073547162
Name:LAWRENCE, DEBRA CRIDER (DPM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:CRIDER
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEACH STREET
Mailing Address - Street 2:BLDG C
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-596-0823
Mailing Address - Fax:401-596-2960
Practice Address - Street 1:85 BEACH STREET
Practice Address - Street 2:BLDG C
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-596-0823
Practice Address - Fax:401-596-2960
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00233213E00000X
CT000453213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI030880OtherHEALTH NET
CT030880OtherHEATH NET
RI030000233RID1OtherANTHEM
T22522Medicare UPIN
CT030880OtherHEATH NET