Provider Demographics
NPI:1578637997
Name:AMOS, LAWRENCE (LMT)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 TILMAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-6338
Mailing Address - Country:US
Mailing Address - Phone:802-338-0644
Mailing Address - Fax:
Practice Address - Street 1:103 FREE BRIDGE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8446
Practice Address - Country:US
Practice Address - Phone:802-338-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0025517173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019008058OtherDEPT. OF HEALTH PROFESSIONS
FLMA 25517OtherSTATE LICENSE NUMBER