Provider Demographics
NPI:1790973014
Name:LAWRENCE, RICHARD JAMES (MA MBBS MRCP)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MA MBBS MRCP
Other - Prefix:DR
Other - First Name:YAACOV
Other - Middle Name:RICHARD
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA MBBS MRCP
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:KIMMEL CANCER CENTER, BODINE BUILDING, G301G
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-5238
Mailing Address - Fax:
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:KIMMEL CANCER CENTER, BODINE BUILDING, G301G
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191840207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0185957Medicaid
PA1022500790001Medicaid
PA143409PAGMedicare PIN