Provider Demographics
NPI:1184405599
Name:PIEPER, LAWRENCE (PA-C)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:PIEPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAWREN
Other - Middle Name:
Other - Last Name:PIEPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:26 WESLEYAN CT APT A
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2922
Mailing Address - Country:US
Mailing Address - Phone:513-519-7461
Mailing Address - Fax:
Practice Address - Street 1:7249 LIBERTY WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1639
Practice Address - Country:US
Practice Address - Phone:513-770-3263
Practice Address - Fax:513-770-3298
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008314363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205213OtherNCCPA PA-C CERTIFICATION
OH50.008314OtherOHIO MEDICAL BOARD LICENSING