Provider Demographics
NPI:1487637435
Name:LAWS, ALLEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
Last Name:LAWS
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 1:205 MOUNTAIN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1839
Mailing Address - Country:US
Mailing Address - Phone:540-236-7673
Mailing Address - Fax:
Practice Address - Street 1:199 HOSPITAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2454
Practice Address - Country:US
Practice Address - Phone:276-236-6136
Practice Address - Fax:276-236-2536
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-040945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006092705Medicaid
VA005816742Medicaid
VA010027055Medicaid
VA006092705Medicaid
110006301Medicare PIN
003351C86Medicare ID - Type Unspecified
VA005816742Medicaid
VA010027055Medicaid