Provider Demographics
NPI:1982651683
Name:LAWNER, BRIAN E (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:LAWNER
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:PO BOX 80074
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-0001
Mailing Address - Country:US
Mailing Address - Phone:781-279-2158
Mailing Address - Fax:781-279-2361
Practice Address - Street 1:38 MONTVALE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2446
Practice Address - Country:US
Practice Address - Phone:781-279-2158
Practice Address - Fax:781-279-2361
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2090472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0136981Medicaid
MAH36328Medicare UPIN
MAA32289Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE