Provider Demographics
NPI:1922009646
Name:LAWRENCE J. KESSEL MD INC.
Entity Type:Organization
Organization Name:LAWRENCE J. KESSEL MD INC.
Other - Org Name:LAWRENCE J. KESSEL MD AND ASSOCIATES,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-482-2336
Mailing Address - Street 1:8200 HENRY AVE
Mailing Address - Street 2:SUITE G 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2984
Mailing Address - Country:US
Mailing Address - Phone:215-482-2336
Mailing Address - Fax:215-483-4339
Practice Address - Street 1:8200 HENRY AVE
Practice Address - Street 2:SUITE G 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2984
Practice Address - Country:US
Practice Address - Phone:215-482-2336
Practice Address - Fax:215-483-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007749810004Medicaid
PA1007749810004Medicaid