Provider Demographics
NPI:1891989406
Name:KORMAN, LAWRENCE T (RN, BSN, CCRP)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:T
Last Name:KORMAN
Suffix:
Gender:M
Credentials:RN, BSN, CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5011
Mailing Address - Country:US
Mailing Address - Phone:301-619-3411
Mailing Address - Fax:301-619-4505
Practice Address - Street 1:1425 PORTER ST
Practice Address - Street 2:
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-5011
Practice Address - Country:US
Practice Address - Phone:301-619-3411
Practice Address - Fax:301-619-4505
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR098611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse