Provider Demographics
NPI:1558315697
Name:WANG, LAWRENCE L (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:WANG
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:PO BOX 428704
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8704
Mailing Address - Country:US
Mailing Address - Phone:513-965-8041
Mailing Address - Fax:513-965-8091
Practice Address - Street 1:321 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8909
Practice Address - Country:US
Practice Address - Phone:513-965-8041
Practice Address - Fax:513-965-8091
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045256A174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20009930AMedicaid
G32336Medicare UPIN
IN20009930AMedicaid
IN236160BMedicare PIN