Provider Demographics
NPI:1477518405
Name:BARTEL, LAWRENCE P (PA)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:BARTEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 637999
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7999
Mailing Address - Country:US
Mailing Address - Phone:317-682-2030
Mailing Address - Fax:317-644-5060
Practice Address - Street 1:1777 NE LOOP 410 STE 704
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5217
Practice Address - Country:US
Practice Address - Phone:210-467-5033
Practice Address - Fax:210-467-5035
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000331A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN7880654OtherAETNA
IN000000723894OtherANTHEM
IN040004473Medicare PIN
INS75847Medicare UPIN
IN000000723894OtherANTHEM
IN112840DMedicare PIN