Provider Demographics
NPI:1326084310
Name:PICKOVER, LAWRENCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:PICKOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:81 VERONICA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3491
Mailing Address - Country:US
Mailing Address - Phone:732-846-2777
Mailing Address - Fax:732-828-1950
Practice Address - Street 1:81 VERONICA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3491
Practice Address - Country:US
Practice Address - Phone:732-846-2777
Practice Address - Fax:732-828-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA058287207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158052A3DMedicare PIN
NJE57571Medicare UPIN