Provider Demographics
NPI:1619902772
Name:LAWRENCE, SHEILA M (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0840
Practice Address - Fax:617-774-0882
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ21343OtherBLUE CROSS
MA080170OtherTUFTS
MAV889OtherHARVARD PILGRIM
MA3196909Medicaid
MA0016498OtherNEIGHBORHOOD HEALTH
MAF22022Medicare UPIN
MAA29618Medicare PIN