Provider Demographics
NPI:1245427392
Name:LAWRENCE W. ADLER MD PA
Entity Type:Organization
Organization Name:LAWRENCE W. ADLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-761-7042
Mailing Address - Street 1:7310 RITCHIE HWY.
Mailing Address - Street 2:SUITE 512
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-761-7042
Mailing Address - Fax:410-761-7984
Practice Address - Street 1:7310 RITCHIE HWY.
Practice Address - Street 2:SUITE 512
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-761-7042
Practice Address - Fax:410-761-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404484300Medicaid
4323821OtherAETNA
MD1993LAOtherBLUE CROSS BLUE SHIELD
DCW714OtherBLUECHOICE
MD1993LAOtherBLUE CROSS BLUE SHIELD