Provider Demographics
NPI:1932107810
Name:KASSAN, LAWRENCE D (DPM)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:KASSAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2719
Mailing Address - Country:US
Mailing Address - Phone:215-336-4151
Mailing Address - Fax:215-336-5111
Practice Address - Street 1:2101 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2719
Practice Address - Country:US
Practice Address - Phone:215-336-4151
Practice Address - Fax:215-336-5111
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-03-17
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
PASC003381L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001279740-0001Medicaid
PA001279740-0001Medicaid
U13303Medicare UPIN