Provider Demographics
NPI:1922090026
Name:LAWLESS, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LAWLESS
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 1:1701 AUGUSTINE CUT OFF
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4415
Mailing Address - Country:US
Mailing Address - Phone:302-652-3016
Mailing Address - Fax:302-571-6270
Practice Address - Street 1:1701 AUGUSTINE CUT OFF
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-4415
Practice Address - Country:US
Practice Address - Phone:302-652-3016
Practice Address - Fax:302-571-6270
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100025342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000018001Medicaid
DE0000018001Medicaid
175580825Medicare ID - Type Unspecified