Provider Demographics
NPI:1093909871
Name:DAVID R LAWRENCE MD LLC
Entity Type:Organization
Organization Name:DAVID R LAWRENCE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-738-3398
Mailing Address - Street 1:200 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098
Mailing Address - Country:US
Mailing Address - Phone:860-738-3398
Mailing Address - Fax:860-738-2267
Practice Address - Street 1:200 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098
Practice Address - Country:US
Practice Address - Phone:860-738-3398
Practice Address - Fax:860-738-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
031325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001313254Medicaid
CTF06162Medicare UPIN
CTC02403Medicare PIN