Provider Demographics
NPI:1851434898
Name:O'CONNOR, LAWRENCE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-242-8816
Mailing Address - Fax:818-242-0610
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-242-8816
Practice Address - Fax:818-242-0610
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA25238207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760619856OtherNPI SCCC
CA1760619856OtherNPI SCCC
CAWA25238AMedicare PIN