Provider Demographics
NPI:1891856373
Name:AGODOA, LAWRENCE Y C (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:Y C
Last Name:AGODOA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13217 GLENHILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3260
Mailing Address - Country:US
Mailing Address - Phone:301-384-9386
Mailing Address - Fax:301-594-9358
Practice Address - Street 1:4650 TAYLOR RD
Practice Address - Street 2:4650 TAYLOR ROAD BLDG 17A RM 3019
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5638
Practice Address - Country:US
Practice Address - Phone:202-782-6462
Practice Address - Fax:202-782-0185
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0035131171000000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology