Provider Demographics
NPI:1558390427
Name:MARKOVITZ, LAWRENCE JAY (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JAY
Last Name:MARKOVITZ
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 1:8180 GREENSBORO DR
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3888
Mailing Address - Country:US
Mailing Address - Phone:703-506-8346
Mailing Address - Fax:
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:SUITE 1015
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3888
Practice Address - Country:US
Practice Address - Phone:703-506-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62098401OtherBCBS
DC035910800Medicaid
MD405450400Medicaid
DCJ6360001OtherBCBS
MDG01508L01Medicare PIN
MD405450400Medicaid