Provider Demographics
NPI:1154499457
Name:MAYER, LAWRENCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:MAYER
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 1:2100 KEYSTONE AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1129
Mailing Address - Country:US
Mailing Address - Phone:610-259-5007
Mailing Address - Fax:610-259-9806
Practice Address - Street 1:2100 KEYSTONE AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1129
Practice Address - Country:US
Practice Address - Phone:610-259-5007
Practice Address - Fax:610-259-9806
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011320 E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000610681Medicaid
PAC27542Medicare UPIN
PA018880Medicare ID - Type Unspecified