Provider Demographics
NPI:1306852736
Name:LAWRENCE, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:LAWRENCE
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 1:200 NEW HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098
Mailing Address - Country:US
Mailing Address - Phone:860-738-3398
Mailing Address - Fax:860-738-2267
Practice Address - Street 1:200 NEW HARTFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098
Practice Address - Country:US
Practice Address - Phone:860-738-3398
Practice Address - Fax:860-738-2267
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001313254Medicaid
AS39958730001OtherCIGNA
OV5198OtherPHS
2109164OtherAETNA US HEALTHCARE
4381225OtherAETNA
936922OtherPHS ACCESS #
010031325CT01OtherBLUE CROSS BLUE SHIELD
00131325401OtherBLUE CARE FAMILY PLAN
031325OtherCONNECTICARE
4381225OtherUNITED HEALTHCARE
936922OtherPHS ACCESS #
031325OtherCONNECTICARE