Provider Demographics
NPI:1639127111
Name:LAWRENCE E MUMIE MD PC
Entity Type:Organization
Organization Name:LAWRENCE E MUMIE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUMIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-454-1444
Mailing Address - Street 1:75 AIRPORT ROAD
Mailing Address - Street 2:STE 104
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9541
Mailing Address - Country:US
Mailing Address - Phone:570-454-1444
Mailing Address - Fax:570-454-1435
Practice Address - Street 1:75 AIRPORT ROAD
Practice Address - Street 2:STE 104
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-9541
Practice Address - Country:US
Practice Address - Phone:570-454-1444
Practice Address - Fax:570-454-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2745474207Q00000X
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory