Provider Demographics
NPI:1942262043
Name:LAWRENCE, GEORGE D (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:D
Last Name:LAWRENCE
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 1:900 CATON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:667-234-2093
Mailing Address - Fax:667-234-3520
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:667-234-2093
Practice Address - Fax:667-234-3520
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0006650207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCW6620041OtherCAREFIRST
MD075221500Medicaid
DCW6620041OtherCAREFIRST
MDK51904UUMedicare ID - Type Unspecified
D74691Medicare UPIN