Provider Demographics
NPI:1487659629
Name:WOMACK, LAWRENCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:H
Last Name:WOMACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:26 RAILROAD AVE # 205
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2204
Mailing Address - Country:US
Mailing Address - Phone:631-277-0051
Mailing Address - Fax:631-277-2690
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE #111
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-277-0051
Practice Address - Fax:631-277-2690
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3298766OtherAETNA/US HEALTHCARE
NY421680216OtherUNITED HEALTHCARE
NY153114OtherVYTRA HEALTHCARE
NYP2912790OtherOXFORD HEALTH PLAN
NY02214588Medicaid
NYP00165433OtherRAILROAD MEDICARE
NY02214588Medicaid
NYP00165433OtherRAILROAD MEDICARE
NYP2912790OtherOXFORD HEALTH PLAN