Provider Demographics
NPI:1194199851
Name:LAWLOR, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CRYSTAL LAKE RD
Mailing Address - Street 2:NAVAL UNDERSEA MEDICAL INSTITUTE BLDG 159
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-2300
Mailing Address - Country:US
Mailing Address - Phone:860-694-6450
Mailing Address - Fax:
Practice Address - Street 1:1 CRYSTAL LAKE RD
Practice Address - Street 2:NAVAL UNDERSEA MEDICAL INSTITUTE BLDG 159
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-2300
Practice Address - Country:US
Practice Address - Phone:860-694-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman