Provider Demographics
NPI:1841230422
Name:KATIN, LAWRENCE I (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:I
Last Name:KATIN
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 1:11 INDUSTRIAL BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1620
Mailing Address - Country:US
Mailing Address - Phone:610-647-6070
Mailing Address - Fax:610-647-6851
Practice Address - Street 1:11 INDUSTRIAL BLVD
Practice Address - Street 2:STE 102
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1620
Practice Address - Country:US
Practice Address - Phone:610-647-6070
Practice Address - Fax:610-647-6851
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040108E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001253251Medicaid
E84018Medicare UPIN