Provider Demographics
NPI:1164406716
Name:LAWSON, JOHN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:LAWSON
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 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5705
Mailing Address - Fax:
Practice Address - Street 1:110 AKERS FARM RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4863
Practice Address - Country:US
Practice Address - Phone:540-382-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010146550207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
314223OtherMAMSI
VA005818290Medicaid
314223OtherOPT CHOICE
541870984OtherVA HEALTH NETWORK
C13214OtherMEDICARE RR GROUP
100000219OtherTRAILBLAZERS
541870984006OtherCHAMPUS
541870984028OtherCIGNA
005818290OtherFIRST HEALTH
110175154OtherTRAVELERS
110175154OtherRR MEDICARE
25106OtherOPTIMA
394397OtherANTHEM HBV
209382OtherANTHEM OBIOI
25106OtherSENTARA
NC790527UMedicaid
110175154OtherRR MEDICARE
25106OtherSENTARA
314223OtherMAMSI
100000219Medicare ID - Type Unspecified