Provider Demographics
NPI:1114242732
Name:JOHN A. LAWSON, MD, LLC
Entity Type:Organization
Organization Name:JOHN A. LAWSON, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-675-1445
Mailing Address - Street 1:10 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1030
Mailing Address - Country:US
Mailing Address - Phone:860-675-1445
Mailing Address - Fax:860-675-1447
Practice Address - Street 1:10 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1030
Practice Address - Country:US
Practice Address - Phone:860-675-1445
Practice Address - Fax:860-675-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001336313Medicaid
CT110007812Medicare UPIN
CTF82286Medicare UPIN