Provider Demographics
NPI:1740210178
Name:ADAMS, LAWRENCE GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GLEN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 N. FRONT STREET
Mailing Address - Street 2:MID STATE MEDICAL INC
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866
Mailing Address - Country:US
Mailing Address - Phone:814-342-7399
Mailing Address - Fax:814-342-5470
Practice Address - Street 1:601 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2303
Practice Address - Country:US
Practice Address - Phone:814-342-7399
Practice Address - Fax:814-342-5470
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD145980L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA656114Medicare ID - Type Unspecified