Provider Demographics
NPI:1376527184
Name:STRATTON, LAWRENCE WILMER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WILMER
Last Name:STRATTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-394-7500
Mailing Address - Fax:617-394-7576
Practice Address - Street 1:19 NORWOOD STREET EHC
Practice Address - Street 2:MGH EVERETT FAMILY CARE
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-2709
Practice Address - Country:US
Practice Address - Phone:617-394-7500
Practice Address - Fax:617-394-7576
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA151476207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3176681Medicaid
MAJ18673OtherBCBS MA
MA750278OtherTUFTS HEALTH PLAN
MAJ18673OtherBCBS MA
MA3176681Medicaid