Provider Demographics
NPI:1639121957
Name:KIDD, LAWRENCE G (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:G
Last Name:KIDD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2310
Mailing Address - Country:US
Mailing Address - Phone:978-682-3686
Mailing Address - Fax:978-794-0841
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-682-3686
Practice Address - Fax:978-794-0841
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-06-23
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Provider Licenses
StateLicense IDTaxonomies
MA41919207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0133957Medicaid
042799825OtherCIGNA
531260OtherAETNA
9200058OtherUNITED HEALTH
MAD13212OtherBLUE CROSS BLUE SHIELD
66729OtherHARVARD PILGRIM
MA703254OtherTUFTS HEALTH PLAN
94070OtherHEALTHSOURCE
0107432YPMA01OtherANTHEM NH
33580OtherFALLON COMMUNITY HEALTH
531260OtherAETNA
MA703254OtherTUFTS HEALTH PLAN