Provider Demographics
NPI:1689617177
Name:LAWRENCE, KAYODE C (MD)
Entity Type:Individual
Prefix:DR
First Name:KAYODE
Middle Name:C
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2768
Mailing Address - Fax:717-729-3162
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-339-2768
Practice Address - Fax:717-798-3162
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058003207R00000X
NY60 251693207RN0300X
PAMD442890207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2655440OtherHIGHMARK BLUE SHIELD
PA102629415Medicaid
PA1602287OtherGATEWAY
PA30103542OtherAMERIHEALTH MERCY-WMG
PA228249FLTMedicare PIN
PAP01220724Medicare PIN
PA102629415Medicaid