Provider Demographics
NPI:1861463507
Name:LAWRENCE, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3855 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 300 MAIN LINE HEALTH CENTER
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-427-8000
Mailing Address - Fax:484-427-8020
Practice Address - Street 1:3855 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 300 MAIN LINE HEALTH CENTER
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:484-427-8000
Practice Address - Fax:484-427-8020
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042833E207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09166Medicare UPIN
F09166Medicare UPIN
PA001428643Medicaid
PA232359401OtherMAIN LINE HEALTHCARE