Provider Demographics
NPI:1093726101
Name:LAWRENCE, MATTHEW W (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E. NEW YORK AVE
Mailing Address - Street 2:4TH FLOOR -SPG
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-653-3994
Mailing Address - Fax:609-926-4311
Practice Address - Street 1:649 SHORE RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2449
Practice Address - Country:US
Practice Address - Phone:609-365-6200
Practice Address - Fax:609-926-4311
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20007648208600000X
PAOS010450L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0712591Medicaid
PA1013649230003Medicaid
DE1000035617Medicaid
DE017640M49Medicare PIN
PA1013649230003Medicaid