Provider Demographics
NPI:1104858109
Name:LAWRENCE BOAS, M.D., P.A.
Entity Type:Organization
Organization Name:LAWRENCE BOAS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-628-6101
Mailing Address - Street 1:54 SCOTT ADAM RD
Mailing Address - Street 2:SUITE# 202
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3216
Mailing Address - Country:US
Mailing Address - Phone:410-628-6101
Mailing Address - Fax:410-628-0131
Practice Address - Street 1:54 SCOTT ADAM RD
Practice Address - Street 2:SUITE# 202
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3216
Practice Address - Country:US
Practice Address - Phone:410-628-6101
Practice Address - Fax:410-628-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTIN
MDC49150Medicare UPIN