Provider Demographics
NPI:1992017321
Name:LAWRENCE P. CLINTON, M.D., P.A.
Entity Type:Organization
Organization Name:LAWRENCE P. CLINTON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-696-2660
Mailing Address - Street 1:1138 E CHESTNUT AVE
Mailing Address - Street 2:BUILDING 6A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:856-696-2660
Mailing Address - Fax:856-696-8548
Practice Address - Street 1:1138 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 6A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-696-2660
Practice Address - Fax:856-696-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA030186002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty