Provider Demographics
NPI:1427038751
Name:O'MALLEY, LAWRENCE (PAC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2551
Mailing Address - Country:US
Mailing Address - Phone:603-224-3368
Mailing Address - Fax:603-224-7815
Practice Address - Street 1:264 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2551
Practice Address - Country:US
Practice Address - Phone:603-224-3368
Practice Address - Fax:603-224-7815
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0520P363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076251Medicaid
NHAP2173Medicare ID - Type Unspecified
NH0389700001Medicare NSC
NHP41961Medicare UPIN