Provider Demographics
NPI:1134124639
Name:NEVILLE, LAWRENCE H (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-636-4814
Practice Address - Fax:360-414-7965
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000449642084N0400X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8905955OtherCRIME VICTIMS
OR022559Medicaid
WA196953OtherLABOR & IND.
WA8402265Medicaid
P00256993OtherRR MEDICARE
OR022559Medicaid
WA8905955OtherCRIME VICTIMS