Provider Demographics
NPI:1477761716
Name:LAWRENCE, DONALD R (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1412 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2908
Mailing Address - Country:US
Mailing Address - Phone:215-599-4851
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:1412 FAIRMOUNT AVE.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-599-4851
Practice Address - Fax:215-232-4093
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001619L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant