Provider Demographics
NPI: | 1295140960 |
---|---|
Name: | LAWLOR, MEGAN LEIGH (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | MEGAN |
Middle Name: | LEIGH |
Last Name: | LAWLOR |
Suffix: | |
Gender: | |
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 7412011 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60674-2011 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 314-454-8181 |
Mailing Address - Fax: | 314-747-1429 |
Practice Address - Street 1: | 4901 FOREST PARK AVE |
Practice Address - Street 2: | DIV OBGYN MFM AND US, STE 710 |
Practice Address - City: | SAINT LOUIS |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63108-1495 |
Practice Address - Country: | US |
Practice Address - Phone: | 314-454-8181 |
Practice Address - Fax: | 314-747-1429 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-06-21 |
Last Update Date: | 2025-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2018004580 | 207V00000X, 207VM0101X, 207VM0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 200052420 | Medicaid |