Provider Demographics
NPI:1891749669
Name:WOHL, LAURENCE STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:STEVEN
Last Name:WOHL
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 1:166 QUINCY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302
Mailing Address - Country:US
Mailing Address - Phone:508-587-5252
Mailing Address - Fax:508-427-4318
Practice Address - Street 1:166 QUINCY AVENUE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302
Practice Address - Country:US
Practice Address - Phone:508-587-5252
Practice Address - Fax:508-427-4318
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC20209OtherBCBS
MA708384OtherTUFTS
MA2032937Medicaid
MA2032937Medicaid
A53825Medicare UPIN