Provider Demographics
NPI:1689769945
Name:SCHISSEL, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:SCHISSEL
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 1:11 JOHN STARK HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-1807
Mailing Address - Country:US
Mailing Address - Phone:603-863-4100
Mailing Address - Fax:603-863-3585
Practice Address - Street 1:11 JOHN STARK HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773
Practice Address - Country:US
Practice Address - Phone:603-863-4100
Practice Address - Fax:603-863-3585
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003085Medicaid
NHA66626Medicare UPIN
NHA66626Medicare UPIN