Provider Demographics
NPI:1902834708
Name:DAVANZO, LAWRENCE D (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:D
Last Name:DAVANZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:49 VERONICA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6802
Mailing Address - Country:US
Mailing Address - Phone:732-246-3066
Mailing Address - Fax:732-246-3067
Practice Address - Street 1:49 VERONICA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6802
Practice Address - Country:US
Practice Address - Phone:732-246-3066
Practice Address - Fax:732-246-3067
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB05407000207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH07550Medicare UPIN