Provider Demographics
NPI:1881660116
Name:PIAZZA, LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:128 BUCKSPORT RD
Mailing Address - Street 2:# B
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2239
Mailing Address - Country:US
Mailing Address - Phone:207-667-6300
Mailing Address - Fax:207-667-9523
Practice Address - Street 1:128 BUCKSPORT RD
Practice Address - Street 2:SUITE B
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2239
Practice Address - Country:US
Practice Address - Phone:207-667-6300
Practice Address - Fax:207-667-9523
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME013347207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127190199Medicaid
E72240Medicare UPIN
MM4322Medicare ID - Type Unspecified