Provider Demographics
NPI:1841215522
Name:DERBY, S LAWSON (MD)
Entity Type:Individual
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First Name:S LAWSON
Middle Name:
Last Name:DERBY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 HERRICK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3012
Mailing Address - Country:US
Mailing Address - Phone:978-927-4110
Mailing Address - Fax:978-232-7057
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:STE 101 MEDICAL GROUP INC
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3012
Practice Address - Country:US
Practice Address - Phone:978-927-4110
Practice Address - Fax:978-232-7057
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-09-24
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Provider Licenses
StateLicense IDTaxonomies
MA216949207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2031400Medicaid
M47223Medicare UPIN
MAA36348Medicare PIN
A36348Medicare Oscar/Certification