Provider Demographics
NPI:1346263381
Name:LAWTON, KENNETH ALLAN (DPM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALLAN
Last Name:LAWTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2215
Mailing Address - Country:US
Mailing Address - Phone:617-566-2756
Mailing Address - Fax:617-566-0275
Practice Address - Street 1:1540 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2215
Practice Address - Country:US
Practice Address - Phone:617-566-2756
Practice Address - Fax:617-566-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1902213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0362905Medicaid
MA0362905Medicaid
MAY70897Medicare ID - Type Unspecified