Provider Demographics
NPI:1497905368
Name:LAWSON, AMIE L (PA)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:L
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:L
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:95 TREMONT ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4738
Mailing Address - Country:US
Mailing Address - Phone:781-934-2400
Mailing Address - Fax:781-934-0001
Practice Address - Street 1:95 TREMONT ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4738
Practice Address - Country:US
Practice Address - Phone:781-934-2400
Practice Address - Fax:781-934-0001
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001141363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30337048Medicaid
ME433303199Medicaid
ME000864901Medicare PIN
ME433303199Medicaid