Provider Demographics
NPI:1255442174
Name:COLEN, LAWRENCE B (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:B
Last Name:COLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6261 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2964
Mailing Address - Country:US
Mailing Address - Phone:757-466-1000
Mailing Address - Fax:757-466-7788
Practice Address - Street 1:6261 E VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2964
Practice Address - Country:US
Practice Address - Phone:757-466-1000
Practice Address - Fax:757-466-7788
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010449772086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
541706870OtherTAX ID
24004907OtherRAILROAD MEDICARE
024565OtherBCBS
VA295243OtherBCBS
15781OtherSENTARA
2218489OtherAETNA
VA295242OtherBCBS
0016493775OtherVA SALES TAX NUMBER
VA006900151Medicaid
VA0101044977OtherVA LICENSE
C08782OtherMEDICARE GROUP
3755OtherASPRS
NC890686CMedicaid
NC890686CMedicaid
C08782OtherMEDICARE GROUP
VA0101044977OtherVA LICENSE
2218489OtherAETNA