Provider Demographics
NPI:1629042296
Name:LAWRASON, JOCK D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOCK
Middle Name:D
Last Name:LAWRASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67 MAPLE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 QUAKER FARMS RD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2732
Practice Address - Country:US
Practice Address - Phone:203-262-9300
Practice Address - Fax:203-264-2696
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021596207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001215961Medicaid
E31389Medicare UPIN
CT290000341Medicare ID - Type Unspecified