Provider Demographics
NPI:1629069653
Name:LAUREN, DAVID M (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:LAUREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4311
Mailing Address - Country:US
Mailing Address - Phone:202-969-2000
Mailing Address - Fax:203-504-8733
Practice Address - Street 1:3000 SUMMER ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4311
Practice Address - Country:US
Practice Address - Phone:202-969-2000
Practice Address - Fax:203-504-8733
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005575L207Q00000X
CT47449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0984672Medicaid
OH4224861Medicare PIN
OH0984672Medicaid