Provider Demographics
NPI:1568479889
Name:WHITE, LAWRENCE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:350 NORTHERN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:518-434-0494
Mailing Address - Fax:518-426-7701
Practice Address - Street 1:350 NORTHERN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1000
Practice Address - Country:US
Practice Address - Phone:518-434-0494
Practice Address - Fax:518-426-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYNY1254132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC58401Medicare UPIN
NY30017BMedicare ID - Type Unspecified