Provider Demographics
NPI:1376527499
Name:MACCREE, LAWRENCE (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:MACCREE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:
Other - Last Name:MACCREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:200 NEW YORK AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5212
Mailing Address - Country:US
Mailing Address - Phone:865-835-5460
Mailing Address - Fax:865-835-5461
Practice Address - Street 1:200 NEW YORK AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5212
Practice Address - Country:US
Practice Address - Phone:865-835-5460
Practice Address - Fax:865-835-5461
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25799207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
201203000OtherDOL
TNP00992974OtherMEDICARE RAILROAD CARRIER
OR213343Medicaid
ORR131372Medicare PIN
TN3734041Medicare PIN
OR213343Medicaid