Provider Demographics
NPI:1316003734
Name:CLINTON, LAWRENCE P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:P
Last Name:CLINTON
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 1:1138 E CHESTNUT AVE
Mailing Address - Street 2:BUILDING 6A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:856-696-2660
Mailing Address - Fax:856-696-8548
Practice Address - Street 1:1138 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 6A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-696-2660
Practice Address - Fax:856-696-8548
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA030186002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074628000OtherAMERIHEALTH
NJ049091OtherVALUE OPTIONS
NJ2920204Medicaid
NJ2920204Medicaid
NJ049091OtherVALUE OPTIONS