Provider Demographics
NPI:1710910005
Name:HOTES, LAWRENCE S (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:HOTES
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 1:150 YORK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1829
Mailing Address - Country:US
Mailing Address - Phone:781-297-1146
Mailing Address - Fax:781-297-1575
Practice Address - Street 1:150 YORK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1829
Practice Address - Country:US
Practice Address - Phone:781-297-1146
Practice Address - Fax:781-297-1575
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0103012Medicaid
MA0103012Medicaid
MAC21045Medicare ID - Type UnspecifiedINDIVIDUAL