Provider Demographics
NPI:1437127271
Name:MORALES, LAWRENCE RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAYMOND
Last Name:MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4911
Mailing Address - Country:US
Mailing Address - Phone:757-547-9301
Mailing Address - Fax:757-548-9263
Practice Address - Street 1:200 MEDICAL PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4911
Practice Address - Country:US
Practice Address - Phone:757-547-9301
Practice Address - Fax:757-548-9263
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6404162Medicaid
VA6404162Medicaid