Provider Demographics
NPI:1437263753
Name:PAOLINI, LAWRENCE (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:PAOLINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N MAIN ST
Mailing Address - Street 2:PO BOX 177
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2119
Mailing Address - Country:US
Mailing Address - Phone:609-465-8788
Mailing Address - Fax:609-465-8643
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2119
Practice Address - Country:US
Practice Address - Phone:609-465-8788
Practice Address - Fax:609-465-8643
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05275300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070002459OtherRAILROAD MEDICARE
009205OtherMEDICARE GROUP PTAN
223086309OtherTAX ID
0057107000OtherAMERIHEALTH PROVIDER ID
223086309OtherTAX ID
B40779Medicare UPIN