Provider Demographics
NPI:1831106269
Name:WEI, LAWRENCE C (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:WEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1001 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8161
Mailing Address - Country:US
Mailing Address - Phone:814-274-7910
Mailing Address - Fax:814-274-8213
Practice Address - Street 1:1001 E 2ND ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-8161
Practice Address - Country:US
Practice Address - Phone:814-274-7910
Practice Address - Fax:814-274-8213
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033374E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5035931OtherWESTERN NEW YORK BC/BS
220038OtherUPMC
180003352OtherRAILROAD MEDICARE
P013516OtherCHAMPUS
PA0010078660005Medicaid
723061OtherHIGHMARK BLUE SHIELD
5035931OtherWESTERN NEW YORK BC/BS
220038OtherUPMC