Provider Demographics
NPI:1275543571
Name:LAWLESS, JOHN M JR (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:LAWLESS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FRIENDS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1803
Mailing Address - Country:US
Mailing Address - Phone:215-579-1300
Mailing Address - Fax:215-579-0150
Practice Address - Street 1:11 FRIENDS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1803
Practice Address - Country:US
Practice Address - Phone:215-579-1300
Practice Address - Fax:215-579-0150
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S008252L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G09470Medicare UPIN
PALA786089Medicare ID - Type Unspecified