Provider Demographics
NPI:1275653065
Name:LAWRENCE, SUSAN E (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44758 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3105
Mailing Address - Country:US
Mailing Address - Phone:661-948-8559
Mailing Address - Fax:661-951-0369
Practice Address - Street 1:44758 ELM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3105
Practice Address - Country:US
Practice Address - Phone:661-948-8559
Practice Address - Fax:661-951-0369
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41677207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0C416770Medicaid
CAC41677OtherMEDICAL LICENSE
CAC41677OtherMEDICAL LICENSE
CABV894ZMedicare PIN